Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Emory University School of Medicine, Atlanta, GA.
J Pediatr. 2022 Jan;240:206-212. doi: 10.1016/j.jpeds.2021.09.016. Epub 2021 Sep 20.
To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs).
In this cross-sectional study, caregivers of patients who presented to 2 urban PEDs completed a survey regarding their children's ACEs, health care utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years of age not requiring acute stabilization. Prevalence estimates were compared with national and state data from the National Survey of Children's Health by calculating risk differences and 95% CIs. The association of cumulative ACEs with caregiver-reported health care utilization patterns was evaluated using ORs.
Among 1000 participants, 28.1% (95% CI 25.3-30.9) had 1 ACE; 17.8% (95% CI15.4-20.2) 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 = .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. Over 85% of caregivers reported never discussing ACEs with their primary care provider. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%).
Given 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.
确定儿科急诊就诊儿童的不良童年经历（ACE）发生率和医疗保健利用模式。
在这项横断面研究中，在 2 家城市儿科急诊就诊的患者的照护者完成了一项关于其子女 ACE、医疗保健利用模式以及接受基于儿科急诊的 ACE 筛查和资源的调查。纳入标准为 0-17 岁、无需急性稳定的、以英语为母语的患者的照护者。通过计算风险差异和 95%置信区间（CI），将患病率估计值与国家儿童健康调查的全国和州数据进行比较。使用比值比（OR）评估累积 ACE 与照护者报告的医疗保健利用模式之间的关联。
在 1000 名参与者中，28.1%（95%CI 25.3-30.9）有 1 项 ACE；17.8%（95%CI 15.4-20.2）有≥2 项 ACE。值得注意的是，累积 ACE 较高的儿童在儿科急诊就诊更频繁（0、1、≥2 次就诊）（OR 1.18，95%CI 1.06-1.30，P=0.002），更有可能因疾病就诊而在儿科急诊就诊（OR 1.16，95%CI 1.04-1.30，P=0.01）。约 9%接触 ACE 的儿童没有初级保健提供者。超过 85%的照护者表示从未与初级保健提供者讨论过 ACE。大多数照护者在儿科急诊就诊时都感到舒适处理 ACE（84.4%），并会使用转介资源（90.4%）。
鉴于 ACE 较多的儿童在儿科急诊就诊更多，且照护者接受儿科急诊基于筛查和干预，儿科急诊就诊可能代表了一个评估和应对弱势群体 ACE 的战略和有利环境。
