179 - Acute Care Visits to Pediatric Emergency Departments and Urgent Care Facilities in Children with Adverse Childhood Experiences (ACEs)

Poster Number: 179
Publication Number: 179.317

Alexa V. Dantzler, Emory University School of Medicine, Atlanta, GA, United States; Maneesha Agarwal, Emory University School of Medicine, Atlanta, GA, United States; Karli Okeson, Emory University School of Medicine, Atlanta, GA, United States; Timothy P. Moran, Emory University, Atlanta, GA, United States

Background: Higher ACE scores have been associated with increased pediatric emergency department (PED) utilization rates amongst children based on caregiver report. However, this has not been evaluated with objective data.

Objective: To characterize healthcare utilization patterns of a cohort of children in relation to their ACE scores.

Design/Methods: This was a prospective chart review of 1,024 patients that were previously enrolled in an ACEs study during a clinical visit to one of two urban PEDs within a large pediatric healthcare system. We reviewed system-wide electronic medical record data in the two years subsequent to study enrollment to assess healthcare utilization. Data abstracted included the frequency of subsequent PED visits, types of clinical presentations, acuity of PED visits, urgent care (UC) visits, and clinic visits including cancellations and no-shows. Patients were stratified by their ACE scores and the presence of a chronic medical condition. Data were reported using descriptive statistics including medians, interquartile ranges, means, standard deviations, frequencies, and percentages. Inferential statistics, including Spearman correlations and rate ratios from Poisson regressions, were used to determine if ACE scores impacted healthcare utilization patterns.

Results: Demographics are shown in table 1. The majority of patients (88.6%) did not have a chronic condition. Nearly half (47.5%) of all patients had at least 1 ACE. Out of 1,024 patients in the original cohort, 436 (42.6%) had no subsequent visit within the healthcare system. Of the remaining 588 (57.4%) patients, there were 2,169 PED and 254 urgent care visits. There was a weak correlation where patients with more ACEs had lower rates of urgent care visits (R= - 0.10, p=0.001), however no other parameter was statistically significant (tables 2-3). This held true even when adjusting for the presence of a chronic condition.Conclusion(s): In this study, there were no significant relationships between ACE scores and subsequent PED visits, appointments, no shows, and cancellation rates. This data is limited as it excluded healthcare utilization patterns external to the pediatric healthcare system and the impact of the COVID-19 pandemic remains unclear. The relationships between ACEs in pediatric patients and their healthcare utilization warrants further investigation.
Alexa Dantzler CVAlexa Dantzler CV.pdf
ACE Scores and Healthcare UtilizationPED visits, UC visits, appointments, no shows, and cancellations based on ACE score. The general structure is: median (IQR) | mean (standard deviation). Data reveal that patients had more subsequent PED visits than UC visits and that overall, no-show and cancellation rates for appointments were low.