Warm Season and Emergency Department Visits to U.S. Children’s Hospitals

Aaron S. Bernstein, Shengzhi Sun, Kate R. Weinberger, Keith R. Spangler, Perry E. Sheffield, Gregory A. Wellenius

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


BACKGROUND: Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES: We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS: This multicenter time-series study leveraged administrative data on 3:8 million ED visits by children and adolescents ≤18 years of age to the EDs of 47 U.S. children’s hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects metaanalytic model to estimate the overall cumulative association. RESULTS: Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR = 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION: During the warm season, days with higher temperatures were associated with higher rates of visits to children’s hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents.

Original languageEnglish
Article number017001
JournalEnvironmental Health Perspectives
Issue number1
StatePublished - Jan 2022


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