Trends in emergency department utilization by patients with chronic conditions aged 15 and over in a tertiary-care Italian pediatric emergency department (2010-2022)

Background: Adolescents and young adults (AYAs) with chronic conditions are increasingly surviving into adulthood, yet little is known on their use of pediatric emergency departments (PEDs). In Italy, most PEDs apply an upper age limit of 15 years, creating challenges in managing patients transitioning from pediatric to adult care. This study describes PED utilization by AYAs with chronic conditions in a tertiary care center. Methods: We conducted a retrospective study at the PED of Padua University Hospital from January 2010 to December 2022. Eligible visits included patients aged ≥ 15 years with chronic conditions. Demographic, clinical, and management data were extracted and analyzed. Trends were assessed using Joinpoint regression. Results: Overall, 2249 (0.7% of total PED visits) involved AYAs with chronic conditions. Visits increased by 241.6% from 2010 to 2011 to 2021-2022, with a significant annual growth of 18.2% after 2015. Most patients were aged 15-18 years (86.8%) and presented with acute symptoms (≥ 94%). Triage data showed 65.1% urgent and 4.4% emergent classifications. Resource use was substantial: 63.7% required laboratory tests, 25.7% imaging, 53.6% specialist consultation, and 37.6% hospital admission. Hemato-oncological diseases were the leading cause of visits, while neuropsychiatric presentations rose from 6% in 2010-2011 to 22% in 2021-2022. Conclusions: Despite institutional age limits, AYAs with chronic conditions increasingly rely on PEDs, often for complex and urgent care. Rising neuropsychiatric visits and persistent non-urgent use highlight gaps in outpatient and transitional care. Structured transition programmes and enhanced collaboration between pediatric and adult services could strengthen continuity and appropriateness of care, with recent pilot initiatives representing a promising step forward.