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A Descriptive Analysis: Infants Presenting to the Pediatric Emergency Department With a Brief Resolved Unexplained
Lindsay McHale, Rumana Siddique1, Andrew J Gienapp1
1Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN.
Insights
Infants with brief, resolved, unexplained events (BRUE) who are Black or have Medicaid insurance face higher admission rates. Social determinants of health influence pediatric emergency department admissions.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Social Determinants of Health
Background:
- Infants presenting to pediatric emergency departments (EDs) with brief, resolved, unexplained events (BRUE) may be influenced by social determinants of health.
- Understanding demographic predictors is crucial for managing BRUE cases and resource allocation.
Purpose of the Study:
- To define the population demographics of infants presenting with BRUE.
- To identify demographic predictors associated with intensive care unit (ICU) admission for BRUE patients.
Main Methods:
- A multicenter, retrospective study analyzed data from 52 hospitals between January 1, 2016, and June 30, 2021.
- Included were infants aged 0-1 year with an ICD-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE).
- Univariate and multivariate logistic regression identified demographic predictors for admission versus discharge.
Main Results:
- Black race (OR=1.252) and Medicaid insurance (OR=1.126) were significantly associated with increased admission risk.
- "Other" race (OR=0.837) and commercial insurance (OR=0.888) were linked to a higher likelihood of discharge.
- Patient sex did not significantly affect admission rates (OR=1.034).
Conclusions:
- Black race and Medicaid insurance are significant predictors of admission for infants with BRUE.
- Demographic factors, particularly social determinants of health, play a role in ED admission decisions for BRUE.
- Future research should explore interventions, like community outreach, to support socially at-risk families and potentially reduce admission rates.
Objectives:
Infants presenting to pediatric emergency departments (EDs) after a choking episode, cyanotic event, or irregular breathing pattern are often diagnosed with a brief, resolved, unexplained event (BRUE). Social determinants of health may affect these patients; therefore, we aimed to define population demographics and determine significant demographic predictors between 2 cohorts-infants presenting with BRUE, and those admitted to the intensive care unit.
Methods:
Using data from the Pediatric Health Information System (Children's Hospital Association, Washington, DC, Lenexa, KS), this multicenter, retrospective study included children aged 0-1 year from 52 hospitals who presented with an International Classification of Diseases-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE) between January 1, 2016, and June 30, 2021. Cohort 1 patients presented to the ED with BRUE; cohort 2 patients were admitted from the ED for BRUE. Univariate and multivariate logistic regression were performed for both cohorts to discover possible demographic predictors.
Results:
Overall, 24,027 patients were evaluated. Patient sex did not affect admission rates (odds ratio [OR] = 1.034; 95% confidence interval [CI], 0.982-1.089; P = 0.2051). Black race (OR = 1.252; 95% CI, 1.177-1.332; P < 0.0001) and Medicaid insurance (OR = 1.126; 95% CI, 1.065-1.19; P < 0.0001) were significantly associated with an increased risk of admission. "Other" race (OR = 0.837; 95% CI, 0.777-0.902; P < 0.0001) and commercial insurance were significantly associated with a greater likelihood of discharge (OR = 0.888; 95% CI, 0.84-0.939; P < 0.0001).
Conclusions:
Black race and Medicaid insurance predicted admission in this patient population, but demographics did not play a role in intensive care unit admission overall. Social determinants of health and demographics therefore appeared to play a role in admission for patients presenting to the ED. Future research could evaluate the effect of focused interventions, such as providing additional resources to socially at-risk families through community outreach, on admission rates of patients with these specific at-risk demographics.
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