Findings

Number of Treat-and-Release ED Visits for Dental Conditions, Overall and by Age Group and Traumatic vs. Nontraumatic Conditions, 2019 and 2020
Figure 1 presents the number of treat-and-release ED visits for dental conditions by age group and trauma status in 2019 and 2020.

• Overall treat-and-release ED visits for dental conditions decreased by 17.7 percent from 2019 to 2020, while treat-and-release ED visits for nontraumatic dental conditions declined by 23.1 percent.
• Nine out of every 10 treat-and-release ED visits for dental conditions were among patients aged 64 years and younger (2019 and 2020).
• Among patients aged 65 years and older, most treat-and-release ED visits for dental conditions were traumatic (62.7% in 2019 and 66.4% in 2020), a substantially greater portion than that seen among patients aged 64 years and younger (35.8% in 2019 and 39.6% in 2020).

Number of Treat-and-Release Emergency Department Visits for Dental Conditions per 100,000 population, Overall and by age group and traumatic vs. nontraumatic conditions, 2019 and 2020
Figure 2 presents U.S. population rates of treat-and-release ED visits for dental conditions, overall and by age group and trauma status from 2019 to 2020, with estimates reflecting the number of visits per 100,000 population.
 

• In 2020, there were 776 dental ED visits per 100,000 people; this was 18.5 percent lower than the number of visits in 2019 (952 per 100,000 people).
• Dental ED utilization declined the most for nontraumatic dental conditions both among those aged 64 years and younger (-24.0%) and those aged 65 years and older (-21.6%).
• In both 2019 and 2020, dental ED utilization was twice as common among those aged 64 years and younger compared with those aged 65 years and older (per 100,000 people: 1,040 vs. 511 [2019]; and 842 vs. 443 [2020]).

Aggregate Cost of Treat-and-Release Emergency Department Visits for Dental Conditions, Overall and by Age Group and Traumatic vs. Nontraumatic Condition , 2019 and 2020
Figure 3 presents estimates of the aggregate cost of treat-and-release ED visits for dental conditions, overall and by age group and traumatic vs. nontraumatic conditions from 2019 to 2020. Costs reflect expenses incurred in the production of hospital services, such as wages, supplies, and utility costs.
 

• Despite declines in utilization, ED costs for dental conditions remained unchanged from 2019 to 2020, with more than 80 percent of total ED costs accruing for those aged 64 years and younger.
• While traumatic dental conditions only comprised 38.2 percent of dental ED visits in 2019 and 42.2 percent of visits in 2020, they accounted for 59.1 percent of the aggregate costs in 2019 and 63.2 percent of the aggregate costs in 2020.
• While older adults (≥65 years) constituted only 9 percent of the dental ED visit volume, they accounted for 18-19 percent of aggregate costs (2019 and 2020).

Cost for Treat-and-Release Emergency Department Visit for Dental Conditions, by age group and traumatic vs. nontraumatic conditions, 2019 and 2020
Figure 4 presents trends in cost for treat-and-release ED visits for dental conditions by age group and traumatic versus nontraumatic conditions from 2019 to 2020. Costs reflect the estimated allowable direct and indirect costs, including labor, supplies, and overhead.7
 

• Between 2019 and 2020, the median hospital cost for an ED visit increased by 17.7 percent for patients aged 64 and younger with traumatic dental conditions, from $248 in 2019 to $292 in 2020. The median hospital cost for an ED visit increased by 16.8 percent for patients aged 65 and older with a nontraumatic dental condition, from $214 in 2019 to $250 in 2020.
• In 2020, costs became more wide-ranging. Most notably, the interquartile range, or the difference between the third quartile and the first quartile, among patients aged 64 years and younger with traumatic dental conditions increased from $358 in 2019 to $459 in 2020, a 28.2 percent increase in variation.
• Among subgroups, the lowest median ED visit cost in 2020 was for nontraumatic dental conditions among patients aged 64 years and younger (median cost: $145, interquartile range [IQR]: $158). The highest cost was for traumatic dental conditions among patients aged 65 years and older (median cost: $916, IQR: $918).

Number of Treat-and-Release Emergency Department Visits for Dental Conditions, by Month and Traumatic vs. Nontraumatic Conditions, 2019 and 2020
Figure 5 presents trends in the number of treat-and-release ED visits for dental conditions each month in 2019 and 2020, by traumatic versus nontraumatic conditions.
 

• The number of ED visits for dental conditions reached a low point (142,000) in April 2020, when such visits were 37.8 percent lower than visits in April 2019 (228,000).
• From May through December 2020, the number of ED dental visits remained at least 14.6 percent lower each month compared with such visits in 2019.
• The persistent lower utilization pattern in 2020 included a 25.8 percent reduction in nontraumatic ED dental visits and a 10.7 percent decline in visits for traumatic conditions during the final 10 months of 2020 compared with visit volumes for the same 10-month period in 2019.

References

1 Owens PL, Manski RJ, Weiss AJ. Emergency Department Visits Involving Dental Conditions, 2018. HCUP Statistical Brief #280. Rockville, MD: Agency for Healthcare Research and Quality; August 2021. www.hcup-us.ahrq.gov/reports/statbriefs/sb280-Dental-ED-Visits-2018.pdf. Accessed February 15, 2024.

2 Barrett ML, Owens PL, Roemer, M. Changes in Emergency Department Visits in the Initial Period of the COVID-19 Pandemic (April-December 2020), 29 States. HCUP Statistical Brief #298. Rockville, MD: Agency for Healthcare Research and Quality; October 2022. www.hcup-us.ahrq.gov/reports/statbriefs/sb298-COVID-19-ED-visits.pdf. Accessed February 15, 2024.

3 Grace H. How did the COVID-19 pandemic affect healthcare spending? Beyond the Numbers: Prices & Spending. 2023 Nov;12(14). U.S. Bureau of Labor Statistics . https://www.bls.gov/opub/btn/volume-12/how-did-the-covid-19-pandemic-affect-healthcare-spending.htm. Accessed February 15, 2024.

4 Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood). 2020 Nov;39(11):2010-2017. doi: 10.1377/hlthaff.2020.00980.

5 McGough M, Amin K, Cox C. How Has Healthcare Utilization Changed Since the Pandemic? Peterson-KFF Health System Tracker, January 2023. www.healthsystemtracker.org/chart-collection/how-has-healthcare-utilization-changed-since-the-pandemic/. Accessed February 15, 2024.

6 Healthcare Cost and Utilization Project. Treat-and-Release Emergency Department Visits for Dental Conditions and Related Costs: Variation Across the United States by Census Region and State, 2016 and 2019. Rockville, MD: Agency for Healthcare Research and Quality; July 2022. https://hcup-us.ahrq.gov/reports/ataglance/AHRQHCUPanalysisDentalEDvsts.pdf. Accessed February 15, 2024.

7 Clinical Classification Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. December 2022. https://hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp. Accessed February 15, 2024.

8 Barrett M. Population Denominator Data Sources and Data for Use with the HCUP Databases (Updated with 2021 Population Data). HCUP Methods Series Report #2022-03. Rockville, MD: Agency for Healthcare Research and Quality; December 2022. https://hcup-us.ahrq.gov/reports/methods/MS2022-03-PopulationReport.pdf. Accessed February 15, 2024.

9 Healthcare Cost and Utilization Project. User Guide: Cost-to-Charge Ratio (CCR) for Emergency Department Files. Rockville, MD: Agency for Healthcare Research and Quality; October 2022. hcup-us.ahrq.gov/db/ccr/ed-ccr/ED-CCR-User-Guide_Public_FINAL.pdf. Accessed February 15, 2024.

10 Pickens GT, Liang L, Roemer M. HCUP Cost-to-Charge Ratio Methodologies. 2021. HCUP Methods Series Report # 2021-05. Rockville, MD: Agency for Healthcare Research and Quality; December 2021. hcup-us.ahrq.gov/reports/methods/MS2021-05-CCR-Methodologies.pdf. Accessed February 15, 2024.

Data Sources

This Statistical Brief uses data from the HCUP 2019 and 2020 Nationwide Emergency Department Sample (NEDS). The analysis included all data from the NEDS that originated from the HCUP State Emergency Department Databases (SEDD) to capture information on ED visits that do not result in an admission (i.e., patients who were treated in the ED and then released from the ED, or patients who were transferred to another hospital). For additional information about the HCUP NEDS, please visit: https://hcup-us.ahrq.gov/nedsoverview.jsp.

 

This Statistical Brief also relies on U.S. population estimates, for 2019 and 2020, using mid-year estimates (April 1-July 1), as reported by the U.S. Census Bureau's Population Estimates Program. The population estimate at any given time starts with a population base (e.g., the last decennial census or the previous point in the time series), adds births, subtracts deaths, and adds net migration (both international and domestic). For additional information, please visit: https://www.census.gov/programs-surveys/popest/tables/2010-2020/national/totals/-national.html.

Population Studied

This Statistical Brief examines treat-and-release ED visits with a first-listed diagnosis of a dental condition, using the Clinical Classification Software Refined (CCSR) for ICD-10-CM diagnoses of DEN001.8 The unit of analysis is a visit, not a person or patient. This means that a person who is admitted to the ED multiple times for a dental condition in 1 year will be counted each time as a separate admission to the ED. Our case definition excludes all ED admissions for dental conditions that led to an inpatient admission to the same hospital for 2019 and 2020 (1.8 percent and 1.9 percent respectively, of all ED visits).

Definitions

Age

Refers to the patient's age at the time of admission. For age-adjusted populations, we relied on the U.S. Census mid-year (July 1) estimates for denominators.

Diagnosis

For ED visits that are treated and released, the first-listed diagnosis represents the condition, symptom, or problem identified in the medical record to be chiefly responsible for the ED services provided. In cases where the first-listed diagnosis is a symptom or problem, a diagnosis has not been established (confirmed) by the provider.

ICD-10-CM

The first-listed diagnosis on an ED record is coded using the ICD-10-CM. The ICD-10-CM is the International Classification of Diseases, Tenth Revision, Clinical Modification coding system. There are over 70,000 ICD-10-CM diagnosis codes.

Clinical Classification Software Refined (CCSR) for ICD-10-CM Diagnoses

The CCSR aggregates over 73,000 ICD-10-CM diagnosis codes into 540 clinically meaningful categories. The CCSR capitalizes on the specificity of the ICD-10-CM coding scheme and allows ICD-10-CM codes to be classified in more than one category. The first-listed diagnosis code is assigned to a single default CCSR code, based on clinical coding guidelines, etiology and pathology of diseases, and standards set by other Federal agencies. This Statistical Brief used CCSR v2023.1. For more information on the CCSR, see https://hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp.

Costs and charges

Total hospital charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS).9 Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a hospital-wide cost-to-charge ratio is used.10 Hospital charges reflect the amount the hospital billed for the entire ED visit and do not include professional (physician) fees. Further information on the Emergency Department Cost-to-Charge Ratio can be found at: https://hcup-us.ahrq.gov/db/ccr/ed-ccr/ed-ccr.jsp. We present nominal dollars, not adjusted for inflation.

Calculations

Percentage change
Percentage change between groups was calculated using the following formula: where group 2 = estimates from 2020 and group 1= estimates from 2019

Population rates
Rates per 100,000 population were calculated using dental treat-and-release ED visit totals in the numerator and population totals from the U.S. Census Bureau in the denominator. Individuals hospitalized multiple times are counted more than once in the numerator.

About HCUP

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level healthcare data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to healthcare programs, and outcomes of treatments at the national, State, and local market levels.

HCUP would not be possible without the contributions of the following data collection Partners from across the United States:

About the NEDS

The HCUP Nationwide Emergency Department Sample (NEDS) is a unique and powerful database that yields national estimates of ED visits. The NEDS was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID). The SEDD capture information on ED visits that do not result in an admission (i.e., patients who were treated in the ED and then released from the ED, or patients who were transferred to another hospital); the SID contain information on patients initially seen in the ED and then admitted to the same hospital. The NEDS was created to enable analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision making regarding this critical source of care. The NEDS is produced annually; it began in 2006. Over time, the sampling frame for the NEDS has changed; thus, the number of States contributing to the NEDS varies from year to year. The NEDS is intended for national estimates only; no State-level estimates can be produced. The unweighted sample size for the 2019 NEDS is 33,147,251 (weighted, this represents 143,432,284 ED visits). The unweighted sample size for the 2020 NEDS is 28,037,034 (weighted, this represents 123,278,165 ED visits).

Suggested Citation

Olaisen RH, Roemer M. Treat-and-Release Emergency Department Utilization and Costs for Traumatic and Nontraumatic Dental Conditions, 2019 and 2020. HCUP Statistical Brief #305. Rockville, MD: Agency for Healthcare Research and Quality; March 2024. www.hcup-us.ahrq.gov/reports/statbriefs/sb305-dental-conditions-2019-2020.pdf.