Pediatric health screening and referral in the ED

Many studies have demonstrated the importance of performing preventive care in the ED. The primary objective of this study was to identify unmet health needs in the ED of the pediatric patient population. The secondary objective was to determine if the patient's parent or guardian would accept health referrals and bring the child to follow up with a doctor.

Age- and sex-specific algorithms concerning preventive care were developed from the US Department of Public Health Clinicians' Book of Preventative Health. A convenience sample of patients and their families who presented to the ED were asked to participate in the study. The exclusion criteria consisted of patients who were institutionalized, unstable, and had parents who were unable to communicate or declined to participate. After 1 week, the parents were followed up by telephone to find out if they had made an appointment with a doctor as recommended. One month after the ED visit, the health care's computer system was queried to confirm that the appointment had been completed. Data were analyzed using SPSS (version 10.0; SPSS, Chicago, Ill), and tests of significance used were the Pearson chi2, frequency test, and crosstabs. This study was institutional review board-approved as exempt.

Two hundred three pediatric patients were enrolled. Most of the patients had a primary care physician (87.1%, 176/203) and insurance (85.6%, 172/203). Only 25 (12.3%) of 203 needed any referrals, with an acceptance rate of 72.0% (18/25) and completion rate of 40% (10/25). The most frequent unmet need was for urine, lead, and anemia screening (19.4%, all 20/103). Few patients needed immunizations (1.0%, 2/203), alcohol screening (2.0%, 2/100), or blood pressure testing (3.0%, 3/100). Analysis of the correlation between getting 1 or more referrals and race was found to have a significant relationship (chi = 19.69, df = 6, P = .003) but not with sex, age group, insurance, or primary care physician (P > .05).

In this study, 12.3% of the patients were found to have unmet health care needs. Insurance status had no bearing on the need for referrals. Assessment in the pediatric population for unmet health care needs was found to be a low-yielding, labor-intensive process.