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OBJECTIVES: To evaluate the association between the Child Opportunity Index (COI) and food insecurity. STUDY DESIGN: This was a secondary analysis of a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in 2 urban pediatric emergency departments to adolescents aged 13-21 years and caregivers of children aged 0-17 years. Food insecurity was assessed using the 2-item Hunger Vital Sign. Residential addresses were geocoded and linked with COI data. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and food insecurity. RESULTS: Of the 954 participants (384 adolescents, 570 caregivers) who underwent screening, 15.7% identified food insecurity (14.3% of adolescent and 16.7% of caregiver participants). The majority of participants were non-Hispanic Black (overall, 62.3%; food secure, 60.9%; food insecure, 72.0%), were publicly insured (overall, 56.6%; food secure, 53.1%; food insecure, 73.3%), and lived in neighborhoods of low/very low opportunity (overall, 76.9%; food secure, 74.7%; food insecure, 88.3%). In adjusted analyses, participants living in neighborhoods of low/very low child opportunity had 3-fold greater odds of being food insecure compared with children living in neighborhoods of high child opportunity (aOR, 3.0; 95% CI, 1.4-6.3). CONCLUSION: We demonstrate that food insecurity is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.
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Abastecimento de Alimentos , Fome , Adolescente , Criança , Estudos Transversais , Insegurança Alimentar , Humanos , Modelos LogísticosRESUMO
OBJECTIVES: To test the hypotheses that (1) rates of mental health-related concerns presenting to pediatric emergency departments (ED) have increased (2) rates are increasing more in minority than nonminority youth. METHODS: We performed a 5-year retrospective cohort study of youth with mental health-related ED visits using the Pediatric Health Information System. We calculated rates of mental health-related visits, in aggregate and by race/ethnicity. The Poisson model was used to generate incidence rate ratios of unique mental health-related visits each year using census data as the population denominator. RESULTS: There were 242,036 mental health-related visits that met the inclusion criteria, representing 160,656 unique patients. Approximately 7% of unique patients had 3 or more mental health-related visits, differing by race/ethnicity (8.75% non-Hispanic [NH]-Black vs 7.01% NH-White; adjusted odds ratio 1.14 [1.03, 1.26]). Overall, there were 42.8 mental health-related ED visits per 100,000 US children. The NH-Black children had higher rates of visits per 100,000 children compared with NH-Whites (66.1 vs 41.5; adjusted relative risk, 1.54 [1.50-1.59]). Mental health-related visits increased from 2012 to 2016 (33.31 [32.92-33.70] to 49.94 [49.46-50.41]). Every racial/ethnic group experienced an increase in rate of presentation over the study period; Hispanics experienced a significantly larger increase compared with NH-White children (P < 0.05). CONCLUSIONS: Mental health-related ED visits among children are increasing overall, disproportionally affecting minority children. The NH-Black children have the highest visit rates, and rates among Hispanics are increasing at a significantly higher rate when compared with NH-Whites. These results indicate need for increased capacity of EDs to manage mental health-related complaints, especially among minority populations.
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Etnicidade , Saúde Mental , Adolescente , Criança , Serviço Hospitalar de Emergência , Hispânico ou Latino , Humanos , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
Introduction: Anaphylaxis is a potentially fatal systemic reaction that requires prompt recognition and targeted treatment. Despite international consensus and national guidelines, there is often incomplete care for pediatric patients discharged from the emergency department (ED) with a diagnosis of anaphylaxis. Our institution experienced wide variability in discharge planning for patients with anaphylaxis. The goal of our study was to improve care at ED discharge for pediatric patients with anaphylaxis using a quality improvement framework. The specific aims were to increase the frequency of patients diagnosed with anaphylaxis who receive an anaphylaxis action plan at ED discharge from 0% to 60% and to increase referrals to an allergy clinic from a baseline of 61%-80% between October 2020 and April 2021. Methods: Targeted interventions included revisions to the electronic health record system, forging interdisciplinary partnerships and emphasizing provider education. Outcome measures were the proportion of patients receiving an anaphylaxis action plan and an allergy clinic follow-up. The balancing measure was the ED length of stay. Results: The study showed an increase in anaphylaxis action plans from 0% to 34%. Allergy clinic referral rates improved from 61% to 82% within the same period. The average length of stay of 347 minutes remained unchanged. Conclusions: Revising the discharge instructions to include an anaphylaxis action plan and reinforcing provider behaviors with educational interventions led to an overall improvement in discharge care for patients with anaphylaxis. Future work will focus on electronic health record changes to continue progress in additional clinical settings.
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OBJECTIVE: To describe the demographics, clinical features, and test results of children referred from their primary provider for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the community setting. STUDY DESIGN: Retrospective cross-sectional study of children ≤22 years of age who were tested for SARS-CoV-2 at a community-based specimen collection site in Washington, DC, affiliated with a large children's hospital between March 21 and May 16, 2020. RESULTS: Of the 1445 patients tested at the specimen collection site for SARS-CoV-2 virus, 408 (28.2%) had a positive polymerase chain reaction test. The daily positivity rate increased over the study period, from 5.4% during the first week to a peak of 47.4% (Ptrend < .001). Patients with fever (aOR, 1.7; 95% CI, 1.3-2.3) or cough (aOR, 1.4; 95% CI, 1.1-1.9) and those with known contact with someone with confirmed SARS-CoV-2 infection (aOR, 1.6; 95% CI, 1.0-2.4.) were more likely have a positive test, but these features were not highly discriminating. CONCLUSIONS: In this cohort of mildly symptomatic or well children and adolescents referred to a community drive-through/walk-up SARS-CoV-2 testing site because of risk of exposure or clinical illness, 1 in 4 patients had a positive test. Children and young adults represent a considerable burden of SARS-CoV-2 infection. Assessment of their role in transmission is essential to implementing appropriate control measures.
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Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/epidemiologia , Serviços de Saúde Comunitária , Adolescente , COVID-19/complicações , Criança , Pré-Escolar , Estudos Transversais , District of Columbia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: To determine pregnancy risk and receptiveness to emergency department (ED)-based pregnancy prevention interventions among adolescents accessing care in the ED. STUDY DESIGN: Cross-sectional electronic survey of adolescent females in a pediatric ED used to calculate the Pregnancy Risk Index, a validated measure estimating the annual risk of becoming pregnant based on recent sexual activity, contraceptive method(s), method-specific contraceptive failure rates, and interest in receipt of ED-based contraceptive services. RESULTS: Of 229 participants, 219 were not pregnant, and 129 reported sexual experience. Overall, 72.4% (n = 166) endorsed negative pregnancy intentions. The overall Pregnancy Risk Index for the 219 nonpregnant participants was 9.6 (95% CI 6.8-12.4), and was 17.5 (95% CI 12.8-22.2) for the 129 sexually experienced participants. A Pregnancy Risk Index greater than the national average of 5 was associated with older age (aOR 3.0; 95% CI 1.5-5.85), nonprivate insurance (aOR 7.1; 95% CI 1.6-32.1), prior pregnancy (aOR 2.7; 95% CI 1.2-6.0), and chief complaint potentially related to a reproductive health concern (aOR 2.6; 95% CI 1.4-5.1). In this cohort, 85.1% (n = 194) believed that the ED should provide information about pregnancy prevention, the majority of whom (64.9%; n = 148) believed that pregnancy prevention services should be offered at all ED visits. CONCLUSION: This study demonstrates a high unintended pregnancy risk among adolescents accessing care in the ED. Adolescents report interest in receiving pregnancy prevention information and services in the ED, regardless of reason for visit. Strategies to incorporate successfully the provision of reproductive health services into ED care should be explored.
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Anticoncepção/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Medição de RiscoRESUMO
OBJECTIVE: To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing testing for a sexually transmitted infection. STUDY DESIGN: We conducted a retrospective cross-sectional electronic health record review of all patients aged 13-19 years who had Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) testing sent from an urban, academic pediatric emergency department in 2012. We abstracted data, including patient demographics, chief complaint, sexually transmitted infection test results, and treatment. We calculated test characteristics comparing clinician judgment for presumptive treatment for a sexually transmitted infection with the reference standard of the actual results of testing for a sexually transmitted infection. RESULTS: Of 1223 patient visits meeting inclusion criteria, 284 (23.2%) had a positive GC and/or CT test result. Empiric treatment was provided in 615 encounters (50.3%). Provider judgment for presumptive treatment had an overall sensitivity of 67.6% (95% CI, 61.8-73.0) and a specificity of 55% (95% CI, 51.7-58.2) for accurate GC and/or CT detection. CONCLUSIONS: Many adolescents tested for GC and CT receive empiric treatment at the initial emergency department visit. Provider judgment may lack sufficient sensitivity and specificity for identifying infected patients, resulting in the potential for undertreatment of true disease, overtreatment of uninfected patients, or both.
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Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Adolescente , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVES: To assess whether clinical decision support, using computerized sexually transmitted infection (STI) risk assessments, results in increased STI testing of adolescents at high risk for STI. STUDY DESIGN: In a 2-arm, randomized, controlled trial conducted at a single, urban, pediatric emergency department, adolescents completed a computerized sexual health survey. For patients assigned to the intervention arm, attending physicians received decision support to guide STI testing based on the sexual health survey-derived STI risk; in the usual care arm, decision support was not provided. We compared STI testing rates between the intervention and usual care groups, adjusting for potential confounding using multivariable logistic regression. RESULTS: Of the 728 enrolled patients, 635 (87.2%) had evaluable data (323 intervention arm; 312 usual care arm). STI testing frequency was higher in the intervention group compared with the usual care group (52.3% vs 42%; aOR 2 [95% CI 1.1, 3.8]). This effect was even more pronounced among the patients who presented asymptomatic for STI (28.6 vs 8.2%; aOR 4.7 [95% CI 1.4-15.5]). CONCLUSIONS: Providing sexual health survey-derived decision support to emergency department clinicians led to increased testing rates for STI in adolescents at high risk for infection, particularly in those presenting asymptomatic for infection. Studies to understand potential barriers to decision support adherence should be undertaken to inform larger, multicenter studies that could determine the generalizability of these findings and whether this process leads to increased STI detection. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02509572.
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Tomada de Decisões Assistida por Computador , Serviço Hospitalar de Emergência , Inquéritos Epidemiológicos/métodos , Melhoria de Qualidade , Infecções Sexualmente Transmissíveis/diagnóstico , Adolescente , Feminino , Humanos , Incidência , Masculino , Pediatria , Fatores Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Método Simples-Cego , População UrbanaRESUMO
OBJECTIVES: To evaluate acceptance of sexually transmitted infection (STI) screening and measure STI prevalence in an asymptomatic adolescent emergency department (ED) population. STUDY DESIGN: This was a prospectively enrolled cross-sectional study of 14- to 21-year-old patients who sought care at an urban pediatric ED with non-STI related complaints. Participants completed a computer-assisted questionnaire to collect demographic and behavioral data and were asked to provide a urine sample to screen for Chlamydia trachomatis and Neisseria gonorrhoeae infection. We calculated STI screening acceptance and STI prevalence. We used logistic regression to identify factors associated with screening acceptance and presence of infection. RESULTS: Of 553 enrolled patients, 326 (59.0%) agreed to be screened for STIs. STI screening acceptability was associated with having public health insurance (aOR 1.7; 1.1, 2.5) and being sexually active (sexually active but denying high risk activity [aOR 1.7; 1.1, 2.5]; sexually active and reporting high risk activity [aOR 2.6; 1.5, 4.6]). Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI. High-risk sexual behavior (aOR 7.2; 1.4, 37.7) and preferential use of the ED rather than primary care for acute medical needs (aOR 4.0; 1.3, 12.3) were associated with STI. CONCLUSIONS: STI screening is acceptable to adolescents in the ED, especially among those who declare sexual experience. Overall, there was a low prevalence of asymptomatic STI. Risk of STI was higher among youth engaging in high-risk sexual behavior and those relying on the ED for acute health care access. Targeted screening interventions may be more efficient than universal screening for STI detection in the ED.