P0234 - Screening for Adverse Childhood Experiences in a Pediatric Emergency Department

Background: Adverse Childhood Experiences (ACEs), classically defined as abuse, violence exposure, and family dysfunction, have been shown to cause long-term negative health effects. Data from the 2011-12 National Survey of Children’s Health (NSCH) revealed that 31.3% of children 0-17 years old in the United States have been exposed to ACEs. This study aimed to define the prevalence of ACEs in a pediatric ED.

Methods: This was a prospective, observational study of children evaluated in one academic, urban, tertiary care pediatric ED. Five-hundred children ages 0-17 years were enrolled from a convenience sample via a survey application on an electronic tablet. The survey used was the (NSCH) section on ACEs. Caregiver-reported child ACE exposure was defined as no ACEs (0), low ACEs (1), or high ACEs (≥2). Confidence intervals were calculated for all proportions. The national prevalence of ACE exposure in this study was compared to the prevalence found in this 2011-2012 NSCH study using a chi-square test of independence.

Results: Patients were excluded if their caregivers’ primary language was not English or Spanish, if no caregiver was present, if the patient was medically unstable, or if they declined to participate. Rates of no, low, and high ACE scores were calculated. In total, 41.4% (95%CI 36.0-47.4) of respondents reported ACE exposure. Specifically, 26.2% (95%CI 21.9-31.1) had low ACE scores and 15.2% (95%CI 12.0-19.0) had high ACE scores. The most frequently reported ACEs were poverty 21.0% (95%CI 17.2-25.4), divorce/separation 18.2% (95%CI 14.7-22.3), and mental illness within the household 7.2% (95%CI 5.0-10.0). When compared to the national prevalence of 31.3%, ACE exposure in this pediatric ED (41.4%) was significantly higher (p < 0.001).

Conclusions: In a single academic, tertiary care center, ACE exposure was significantly higher than in the nationally representative population surveyed in the NSCH study. The ACE exposures most commonly reported were poverty, divorce/separation, and mental illness within the household. These results suggest this group is of particular import when attempting to mitigate these risk factors for long-term adverse health outcomes.