Objective:
The purpose of this investigation is to describe the breadth of emergency visits of children with cardiac diseases less than 2 years of age, enrolled in a program to prepare for emergencies of children with heart disease.

Methods: Children treated for heart failure or arrhythmia and those who have undergone cardiac surgery had presenting complaint, results and charges from emergency visits tabulated from 9/26/02 to 2/28/05. Children were drawn from the 3 cardiac programs in a US metropolitan area. Visits not including new presentations.

Results: 170 children had 189 emergency visits in 1.72 years, average 0.65 visits per patient/year of study with 44 admissions (23%) including 8 critical admissions. Cardiac diagnoses for the children included TOF 15%, VSD 15%, Aortic Coarctation 13%, Transposition 12%, SVT 6% and other congenital anomalies. The presenting complaints included the following emergencies: 19 cardiac (including 15 visits for arrhythmia, 1 cardiac arrest, 2 heart failure, 1 hypercyanotic spell), 60 respiratory (23 difficulty breathing, 18 cough, 7 wheezing, 6 hypoxia, 1 respiratory arrest, 1 apnea), 48 gastrointestinal, 39 infectious (30 fever and 7 otitis), neuro 10, trauma 7, and skin 6. ED charges averaged $1205 +/-$1260 and varied with age of child (p<0.0001).

Conclusions: Children with known heart disease rarely present with important cardiac emergencies other than SVT. Emergencies related to feeding issues were common. Hospital admission rate of 23% equals published literature but the ED visit rate of 0.65 visits/year is 3 times the usual rate for other Children with Special Health Care Needs.