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Parental Childhood Adversity and Pediatric Emergency Department Utilization: A Pilot Study
Rachel M Weigert1, Brianna S McMichael2, Heidi A VanderVelden2
1From the Department of Pediatric Emergency Medicine.
Insights
Parental adverse childhood experiences (ACEs) increase pediatric emergency department (PED) visits. However, high parental resilience can reduce severe visits and 72-hour returns, mitigating the impact of parental ACEs.
Area of Science:
- Pediatric Emergency Medicine
- Childhood Trauma Research
- Public Health
Background:
- Adverse Childhood Experiences (ACEs) are linked to adult healthcare use.
- The effect of parental ACEs on pediatric emergency department (PED) utilization remains unexamined.
- Understanding this link is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between parental ACEs and PED utilization.
- To assess the impact of parental ACEs on visit frequency, acuity, and 72-hour return rates.
- To explore the moderating role of resilience in this relationship.
Main Methods:
- Cross-sectional survey design utilizing validated ACEs and resilience measures.
- Data collected via iPad surveys in PEDs and linked to electronic health records.
- Pearson correlation analysis to examine associations between variables.
Main Results:
- Parental ACEs correlated positively with the frequency of PED visits.
- High parental resilience was linked to fewer severe acuity visits.
- Increased parental resilience was associated with reduced 72-hour PED return rates.
Conclusions:
- Parental ACEs are associated with increased PED utilization frequency.
- Parental resilience may buffer the negative impact of ACEs on PED visits.
- Interventions promoting parental resilience could improve pediatric care outcomes.
Objectives:
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.
Methods:
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.
Results:
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).
Conclusions:
Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.
