Pediatric Emergency Medicine Fellow Children's Minnesota Children's Minnesota, Minnesota, United States
Background: Adverse Childhood Experiences (ACEs) including physical and emotional abuse or neglect, sexual abuse, and/or exposure to household instability have been associated with adult emergency department (ED) utilization, but the impact of parental ACEs in pediatric ED (PED) utilization has not been studied.
Objective: The primary aim was to determine if parental ACEs impact 1) frequency of PED utilization, 2) acuity PED visits, and 3) 72-hour PED return rates. The secondary aim was to determine if resilience and social determinants of health (SDH) interact with the impact of parental ACEs on PED utilization.
Design/Methods: This was a cross-sectional survey study utilizing previously validated components of the Philadelphia ACEs questionnaire, Brief Resiliency Scale, and questions regarding hunger, household stressors, and parental depression. [RW1] Surveys were administered via iPad by research assistants (RAs) in our institution’s PEDs utilizing a randomization protocol where two of every three eligible families were approached for enrollment.[RW2] Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson’s correlation and a negative binomial model were used to identify correlation between ACEs, SDHs, and ED utilization measures.
Results: Parental ACEs were positively associated with frequency of PED visits (Incidence Rate Ratio [IRR] = 1.013, 95% CI 1.001-1.024). [RW1] In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits, and was associated with fewer 72 hour PED return visits. Conclusion(s): Parental ACEs appear to be positively associated with frequency of PED utilization, and inversely associated with higher acuity PED visits and parental resiliency.
Predicted values from the main effects-only model showing parental ACEs impact on number of PED visits and parental resiliency impact on 72 hour return rates.
Authors/Institutions: Rachel Weigert, Children's Minnesota, Minneapolis, Minnesota, United States; Brianna McMichael, Children's Minnesota Research Institute, Minneapolis, Minnesota, United States; Heidi Vander Velden, Children's Minnesota Research Institute, Minneapolis, Minnesota, United States; Daniel B. Lee, Children's Minnesota Research Institute, Minneapolis, Minnesota, United States; Gretchen Cutler, Children's Minnesota Research Institute, Minneapolis, Minnesota, United States; Michael Troy, Children's Minnesota, Minneapolis, Minnesota, United States; Kelly R. Bergmann, Children's Minnesota, Minneapolis, Minnesota, United States
