{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:26:53Z","timestamp":1790400413058,"version":"4.1.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Sickle cell disease (SCD) is a complex hemoglobinopathy. Vaso-occlusive episodes are the primary cause of emergency department (ED) utilization among individuals with SCD. Literature lacks a standardized definition for high ED utilization.<\/jats:p><\/jats:sec>Objective<\/jats:title>To explore ED utilization, redefine high ED utilization, and describe factors associated with super-high ED utilization among individuals with SCD.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study analyzed the North Carolina Hospital Discharge Datasets (2013-2019). Participants were included if they had SCD, defined as at least 3 SCD visits (ED, inpatient, or outpatient surgery) in a rolling 5-year period. All age groups, sexes, and payers, regardless of state of residence, were included. Data were analyzed from July 2023 to August 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Variables included sex, race, ethnicity, age, age at death, distance (in miles) to the closest SCD center, number of annual ED visits, and social vulnerability index (SVI).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>To determine ED utilization categories, first the distribution of people based on the number of annual ED visits was examined, then the categories across years were identified to determine the data-informed cutoff for each category. Univariate analysis determined differences between participants based on the ED utilization category using \u03c72<\/jats:sup> tests of independence or analysis of variance, as applicable. Descriptive statistics were conducted to describe characteristics of utilization in the sample and by ED utilization group. A parsimonious multinomial regression was conducted using significant factors from the univariate analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 9964 unique patients (5364 [53.83%] female; mean [SD] age, 24.49 [17.54] years), including 9355 Black patients (93.89%), with 100\u202f188 total ED visits from 2013 to 2019. ED visits were categorized into 4 levels: low (0-1 visits per year), moderate (2-9 visits per year), high (10-32 visits per year), and super high (\u226533 visits per year). A small subset (178 patients [1.79%]) exhibited super-high ED utilization, contributing disproportionately to the total number of ED visits. Older age, younger age for in-facility deaths, and higher SVI were significantly associated with higher ED utilization. Patients with high utilization were more likely to die, die younger (eg, median [IQR] age at death, 33.0 [30.0-44.0] years in the super-high utilization group vs 50 [38.0-61.0] years in the moderate utilization group), use multiple EDs (eg, 93.8% of participants in the super-high utilization group vs 40.08% of participants in the moderate utilization group), and reside in counties more disadvantaged on socioeconomic and transportation characteristics.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study of 7 years of North Carolina Hospital Discharge Data described 4 new categories of ED utilization in SCD. These categories could be used to reframe how high ED use is determined.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.13361","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T15:01:09Z","timestamp":1748876469000},"page":"e2513361","source":"Crossref","is-referenced-by-count":11,"title":["Redefining High Emergency Department Utilization for Sickle Cell Disease"],"prefix":"10.1001","volume":"8","author":[{"given":"Paula","family":"Tanabe","sequence":"first","affiliation":[{"name":"Duke University School of Nursing, Durham, North Carolina"},{"name":"Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Pan","sequence":"additional","affiliation":[{"name":"Duke University School of Nursing, Durham, North Carolina"},{"name":"Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey 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