Weigert Rachel M, McMichael Brianna S, VanderVelden Heidi A, Lee Daniel B, Cutler Gretchen J, Troy Mike F, Bergmann Kelly R
From the Department of Pediatric Emergency Medicine.
Children's Minnesota Research Institute, Children's Minnesota, Minneapolis.
Pediatr Emerg Care. 2022 Dec 1;38(12):665-671. doi: 10.1097/PEC.0000000000002875. Epub 2022 Nov 14.
Adverse childhood experiences (ACEs) including physical, emotional, or sexual abuse; neglect; and/or exposure to household instability have been associated with adult emergency department utilization, but the impact of parental ACEs on pediatric emergency department (PED) utilization has not been studied. The primary aim was to determine if parental ACEs impact resource utilization as measured by (1) frequency of PED utilization, (2) acuity of PED visits, and (3) 72-hour PED return rates. The secondary aim was to determine if resilience interacts with the impact of parental ACEs on PED utilization.
This study is a cross-sectional survey using previously validated measures of ACEs, resiliency, and social determinants of health screening. Surveys were administered from October 17, 2019, to November 27, 2019, via iPad by research assistants in our institution's PEDs. Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson correlation was used to identify correlation between ACEs, social determinants of health, and PED utilization measures.
A total of 251 parents had complete data. Parental ACEs were positively associated with frequency of PED visits (incidence rate ratio, 1.013). In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits and were associated with fewer 72-hour return visits (incidence rate ratio, 0.49).
Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.
童年不良经历（ACEs），包括身体、情感或性虐待；忽视；和/或暴露于家庭不稳定环境，已被证明与成人急诊科就诊率有关，但父母的ACEs对儿科急诊科（PED）就诊率的影响尚未得到研究。主要目的是确定父母的ACEs是否会影响资源利用，具体衡量指标为：（1）PED就诊频率；（2）PED就诊的严重程度；（3）72小时内PED复诊率。次要目的是确定心理韧性是否会与父母的ACEs对PED就诊率的影响产生相互作用。
本研究是一项横断面调查，采用先前验证过的ACEs、心理韧性和健康筛查社会决定因素的测量方法。2019年10月17日至2019年11月27日，研究助理通过iPad在我们机构的儿科急诊科进行调查。调查回复与从电子健康记录中提取的数据相关联。描述性统计用于描述我们的研究人群。Pearson相关性分析用于确定ACEs、健康的社会决定因素与PED利用指标之间的相关性。
共有251名家长提供了完整数据。父母的ACEs与PED就诊频率呈正相关（发病率比为1.013）。此外，高水平的父母心理韧性减弱了父母的ACEs与严重程度较高就诊次数之间的关联，且与72小时内复诊次数减少有关（发病率比为0.49）。
父母的ACEs似乎与PED就诊频率呈正相关，与较高严重程度的PED就诊及父母心理韧性呈负相关。
