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Evaluation of Emergency Department Visits by Refugee Children in Rhode Island
Giovanna Deluca1, Timmy Lin1, Janette Baird1
1Brown University, Department of Emergency Medicine, Providence, Rhode Island.
Insights
Pediatric refugees frequently use emergency departments for medical and trauma care. Cultural and social factors significantly influence their healthcare-seeking behaviors, particularly for mental health needs.
Area of Science:
- Pediatric healthcare
- Public health
- Refugee health
Background:
- Children represent 40% of global refugees and often present with complex medical needs.
- Understanding emergency department (ED) utilization is crucial for addressing pediatric refugee healthcare requirements.
Purpose of the Study:
- To analyze emergency department (ED) utilization patterns among pediatric refugees (aged 0-18) within a state healthcare system.
- To identify key demographic, linguistic, and geographic factors associated with ED visits.
- To explore patterns in medical, trauma, and mental health visits.
Main Methods:
- Retrospective chart review of pediatric refugee encounters (2015-2023) using the ICD-10 code 'refugee health exam'.
- Descriptive analysis of 483 identified encounters, examining patient demographics, languages, residency, triage levels, and visit outcomes.
- Analysis of visit types (medical, trauma, mental health) by primary language group.
Main Results:
- Arabic, Swahili, and Pushto were the most common languages among 22 identified.
- Most pediatric refugees resided near tertiary care EDs; however, one outlying ZIP code disproportionately contributed to trauma incidents.
- Medium-low acuity visits predominated (79.5%), with 87.8% discharged. Arabic speakers had the most medical and trauma visits, while Swahili and Spanish speakers had the most mental health visits.
Conclusions:
- Cultural, spatial, and social factors significantly influence ED use in pediatric refugees.
- Targeted interventions are needed to address trauma and mental health-seeking behaviors within this population.
- Healthcare systems must consider linguistic and cultural nuances for effective pediatric refugee care.
Abstract:
Children constitute 40% of the world's refugees and often have complex medical needs. This retrospective chart review examined Emergency Department (ED) utilization by pediatric refugees (aged 0-18) within a state-level healthcare system to understand the healthcare needs of this population. Pediatric refugee patients were defined as under the age of 18 years with the presence of the ICD-10 code "refugee health exam" in their electronic medical record (EMR). Between 2015-2023, 483 encounters were identified. Descriptive analysis was conducted on characteristics of these encounters. Arabic, Swahili, and Pushto were the most common primary languages of the 22 total languages identified. Most patients resided near the pediatric and adult tertiary care ED, but notably there was one ZIP code outside of the city that represented only 3.3% of all encounters but contributed to 10.6% of traumatic incidents. Medium-low acuity triage levels predominated (79.5%) with 87.8% of patients discharged. The highest percentage of medical (36%) and trauma (28%) visits were by Arabic speakers. Swahili and Spanish speakers had the highest percentage of mental health visits (50%, 36%). Although Arabic speakers had most patient encounters, they had no mental health visits. This study underscores the importance of exploring cultural, spatial, and social influences on ED visits, especially for trauma and mental health-seeking behavior in the pediatric refugee population.
