City Mouse, Country Mouse: Characteristics of Adolescents Presenting to an Urban Children’s Hospital vs a Rural Emergency Department

Adolescents account for a substantial share of emergency department (ED) visits yet remain underserved in the broader health system, often lacking longitudinal primary care and relying on EDs for essential services. This study compares the demographics and presenting complaints of adolescents seeking emergency care in rural hospitals versus an urban children’s hospital to better define their distinct needs.

This retrospective matched-cohort study included all adolescents aged 11–18 years presenting to emergency facilities in West Michigan during 2024. Five rural critical access hospitals and one urban children’s hospital participated. Each rural patient was matched by date of presentation to a patient seen at the urban children’s ED. Demographics, triage category, mode of arrival, chief complaint, diagnosis, and disposition were abstracted from electronic records. Categorical variables were compared using Chi-square or Fisher’s Exact tests, and continuous variables with Student t-tests. A multivariable model assessed independent predictors of hospital type.

A total of 5,819 adolescents were included; 2,819 from rural centers and 3,000 from the urban children’s hospital. Rural patients were older (15.0 vs 14.0 years, p<0.001), Caucasian (90.7 vs 60.6%, p<0.001), commonly insured by Medicaid (48.2 vs 42.3%, p<0.001), and more likely to re-present within 30 days (11.0 vs 7.7%, p<0.001). The urban cohort was more racially and ethnically diverse, more likely to arrive by EMS (11.4 vs 4.0%, p<0.001), have traumatic injuries (49.6 vs 42.3%, p<0.001), and receive social work consults (4.8 vs 1.3%, p<0.001). Most rural encounters were nonurgent (64.4 vs 39.4%, p<0.001), and few required admission (0.2 vs 6.6%, p<0.001).

Adolescents presenting to rural EDs are older, predominantly White, frequently Medicaid insured, and more often evaluated for nonurgent conditions with very low admission rates. Urban children’s hospital patients are more diverse and have higher rates of trauma, EMS use, social work involvement, and admission. These differences highlight the need for tailored strategies to optimize adolescent emergency care in both rural and urban settings.