Examination of Caregiver Social Factors and Its Influence on Low-Acuity Pediatric Emergency Department Utilization

Abstract

Objectives: 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.Methods: 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.Results: 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]).Conclusions: 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.

Parental Childhood Adversity and Pediatric Emergency Department Utilization

“…33 In addition, the complex interaction of ACEs, resiliency, and race have been shown to have variable impact on child flourishing. 34 These results expound upon a recently published article by Murray et al 35 who assessed the impact of parental ACEs on lowacuity PED utilization. Significant differences between their study and ours included only enrolling English-speaking participants, whereas ours also enrolled Spanish-speaking patients and attempted enrollment of Somali-and Hmong-speaking patients, and noting that more than 95% of the participants had a pediatrician, whereas, in our study, the number was 53%.…”

Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population

“…In contrast, Bhattarai et al found that ACEs did not predict future ED use among children and adolescents with pre-existing mental health conditions [ 30 ]. Additionally, Murray et al found that a history of ACEs among parents and caregivers was not associated with low acuity ED use for their children [ 31 ].…”