Center for Violence Prevention, Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Emerg Care. 2022 Feb 1;38(2):e611-e617. doi: 10.1097/PEC.0000000000002426.
Social factors, such as adverse childhood experiences (ACEs), often influence health care utilization. Our study explores the association between caregiver social factors and low-acuity pediatric emergency department (ED) utilization, with the hypothesis that caregivers with high ACE exposure may use ED services more frequently for low-acuity complaints.
In this case-control study, we performed surveys of caregivers with children aged 1 to 12 years registered for care in our pediatric ED. We defined high utilizers (cases) as those children with ≥3 low-acuity visits in the previous year and low utilizers (controls) as having no prior low-acuity visits, exclusive of the current visit. We compared the proportion of high ACE exposure (≥4 ACEs) between both groups.
We enrolled 114 cases and 134 controls. We found no association between number of ACEs and odds of being a case or control (ED utilization). Demographics were significantly different between the 2 groups (ie, caregiver age, race, education, and household income); caregiver ACE exposure was high in both groups (20.2% cases vs 29.1% controls with [≥4 ACEs]).
Although we did not find an association between caregiver ACEs and frequent low-acuity pediatric ED utilization, our data shed light on the overall prevalence of caregiver ACEs in families that seek care in our pediatric ED, even for the first time. Our findings emphasize the risk of conscious bias that can lead to inaccuracy: assuming that it is only high utilizers who experience social stressors. Future work should explore the contribution of structural inequities that influence caretakers' decisions to seek care for their children for low-acuity complaints, and consider types of interventions that could address and mitigate these inequities.
社会因素，如不良童年经历（ACEs），通常会影响医疗保健的利用。我们的研究探讨了照顾者社会因素与低 acuity 儿科急诊部（ED）利用之间的关联，假设 ACE 暴露水平高的照顾者可能更频繁地因低 acuity 投诉而使用 ED 服务。
在这项病例对照研究中，我们对在我们儿科 ED 注册的 1 至 12 岁儿童的照顾者进行了调查。我们将高利用者（病例）定义为前一年≥3 次低 acuity 就诊的儿童，低利用者（对照）定义为无先前低 acuity 就诊，不包括本次就诊。我们比较了两组之间 ACE 暴露（≥4 ACE）的比例。
我们纳入了 114 例病例和 134 例对照。我们没有发现 ACE 数量与成为病例或对照（ED 利用）的几率之间存在关联。两组的人口统计学特征存在显著差异（即照顾者年龄、种族、教育程度和家庭收入）；两组的照顾者 ACE 暴露率均较高（病例中有 20.2%，对照中有 29.1%有[≥4 ACEs]）。
尽管我们没有发现照顾者 ACEs 与频繁低 acuity 儿科 ED 利用之间存在关联，但我们的数据揭示了在我们儿科 ED 寻求护理的家庭中照顾者 ACEs 的总体流行率，即使是首次就诊。我们的研究结果强调了有意识偏见的风险，这种偏见可能导致不准确：认为只有高利用率者才会经历社会压力源。未来的工作应该探讨影响照顾者为孩子因低 acuity 抱怨而寻求护理的结构性不平等的贡献，并考虑可以解决和减轻这些不平等的干预措施。
