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An underrecognized population in pediatric emergency care: process challenges for children deprived of liberty

Yesim Ece Unsal1, Yuksel Bicilioglu2, Tugce Nalbant2

  • 1Pediatric Emergency Department, Ministry of Health Izmir City Hospital, Izmir, Turkey.

International Journal of Prison Health
|July 25, 2026
PubMed

Insights

Pediatric emergency care for youth deprived of liberty improved with workflow interventions. These changes reduced prolonged emergency department length of stay (ED-LOS) by addressing diagnostic and consent processes.

Area of Science:

  • Pediatric Emergency Medicine
  • Health Services Research
  • Vulnerable Populations Care

Background:

  • Children deprived of liberty are a vulnerable group often overlooked in pediatric emergency settings.
  • Understanding their unique needs and care processes is crucial for improving health outcomes.

Purpose of the Study:

  • To characterize clinical and process factors for children deprived of liberty in emergency departments.
  • To identify determinants of emergency department length of stay (ED-LOS).
  • To evaluate the impact of workflow interventions on ED-LOS.

Main Methods:

  • Retrospective, pre-post evaluation of a tertiary pediatric emergency department.
  • Included children deprived of liberty presenting during the study period.
  • Primary outcome: ED-LOS; prolonged ED-LOS defined as >8 hours. Secondary outcomes: diagnostic testing, imaging, consultations, hospitalization, and workflow barriers.

Main Results:

  • 114 encounters analyzed; mean age 16.04 years, 86% male. Common presentations: foreign body ingestion, trauma.
  • Prolonged ED-LOS (>8 hours) occurred in 14.9% of encounters.
  • Interventions reduced prolonged ED-LOS from 20.3% to 6.7% (p=0.046). Diagnostic processes, consultations, and consent barriers were linked to ED-LOS.

Conclusions:

  • This study offers process-oriented insights into pediatric emergency care for children deprived of liberty in Türkiye.
  • Prolonged ED-LOS is associated with diagnostic, consultation, and disposition workflows, not presentation timing.
  • Workflow interventions show promise in reducing prolonged emergency department stays for this population.
Abstract

Keywords:
ChildCorrectional healthcareEmergency serviceHealth in prisonHealth policyHospitalHuman rightsInformed consentJustice-involved youthLength of stayMedical ethicsPrison medicine

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