Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments.

Abstract

OBJECTIVE\nTo determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs).\n\n\nSTUDY DESIGN\nIn this cross-sectional study, caregivers of patients who presented to two urban PEDs completed a survey regarding their children s ACEs, healthcare utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years not requiring acute stabilization. Prevalence estimates were compared with national and state data from the National Survey of Children s Health (NSCH) by calculating risk differences and 95% confidence intervals (CI). The association of cumulative ACEs with caregiver-reported healthcare utilization patterns were evaluated using odds ratios (OR).\n\n\nRESULTS\nAmong 1,000 participants, 28.1% (95% CI:25.3-30.9) had 1 ACE; 17.8% (95% CI:15.4-20.2) had ≥2 ACEs. Notably, children with higher cumulative ACEs were seen in the PED more frequently (0, 1, ≥ 2 visits) (OR:1.18, 95% CI:1.06-1.30, p=0.002) and more likely to seek care in PEDs for sick visits (OR:1.16, 95% CI:1.04-1.30, P = .01). About 9% of children exposed to ACEs did not have a primary care provider (PCP). Over 85% of caregivers reported never discussing ACEs with their PCP. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%).\n\n\nCONCLUSION\nGiven higher PED utilization in children with more ACEs and caregiver acceptance of PED-based screening and intervention, PEDs may represent a strategic and opportune setting to both assess and respond to ACEs among vulnerable populations.