Admission screening for secondhand tobacco smoke exposure

Secondhand smoke (SHS) exposure is an important and preventable cause of mortality and morbidity among children; hospitalization represents a sentinel event that may offer opportunities for intervention. The goal of this study was to determine the frequency and validity of SHS exposure screenings by emergency department (ED) providers, residents, and nurses.

A total of 140 inpatient pediatric families consented to a salivary cotinine measurement, in-person SHS exposure interview, and chart review to assess ED provider, pediatric resident, and nurse SHS exposure screenings and documentation validity.

ED providers documented screening for SHS exposure 46% of the time, pediatric residents 42% of the time, and nurses 79% of the time. ED providers, pediatric residents, and nurses reported 18%, 38%, and 12% of patients exposed to SHS, respectively, whereas 46% of patients were identified as smoke-exposed according to cotinine level and/or parent report. Those with SHS exposure outside the home were least likely to be identified as exposed.

The majority of smoke-exposed children were not identified as exposed based on documentation of admission screenings. Future research is important to identify accurate and efficient methods of screening for and identifying SHS exposure among children admitted to the hospital.