P0513 - Parental Childhood Adversity and Pediatric Emergency Department Utilization: A Pilot Study

Background: Adverse Childhood Experiences (ACEs) include physical, emotional, and sexual abuse or neglect as well as exposure to household instability including substance abuse, mental illness, incarceration, or domestic abuse. Among adult patients, ACEs have been associated with increases in emergency department (ED) utilization. However, the impact of parental ACEs on children in pediatric ED (PED) utilization has not been studied.

Objective: Our primary aim was to determine whether parental ACEs experienced in the first 18 years of their life impacts healthcare utilization for their children in the form of 1) frequency of PED utilization, 2) the number of low acuity PED visits (Emergency Severity Index levels 4 and 5), and 3) 72 hour return rate. Our secondary aim was to determine whether self-reported parental resilience modified the impact of parental ACEs on PED utilization.

Methods: This study utilized previously validated measures of ACEs, resilience, and social determinants of health (SDH) screening tools to construct a survey for parents of patients presenting to one of two tertiary care PEDs. Surveys were administered to parents via iPad by research assistants utilizing a randomization protocol. Survey responses were linked to patient data abstracted from the electronic health record for 12 months prior to their enrollment visit. Negative binomial regression models were estimated to examine the study aims. Endorsement of ACEs were measured as a percentage of total voluntary ACE responses. All models controlled for gender, age, chronic illness, race, parental depression, and social needs.

Results: Data was analyzed from 269 parental surveys. Of the population sampled, 54% of the children were male, median age was 7.43, 47% were non-white, and 37% had reported chronic illness. Parents endorsed 36% of the items on the ACEs, and reported a moderate level of resilience (Median = 2.71). Higher levels of parental ACEs were significantly associated with increased number of PED visits in the preceding year (Incidence Risk Ratio (IRR) = 1.01, Figure 1). Resilience did not modify this association; however, resilience did significantly modify the association between parental ACEs and low acuity ED utilization during the past year (IRR = 0.99, Figure 2a). Specifically, ACEs were associated with increased high acuity ED utilization for parents with below average levels of resilience (IRR = 1.01, Figure 2a), but not at average or above average levels of resilience. Lastly, while resilience did not modify the association between ACEs and the 72 hour return rate, resilience alone was inversely associated with the 72 hour return rate (IRR = 0.49, Figure 2b).

Conclusion: Parental experience of adversity in childhood appears to be positively associated with overall frequency of PED utilization. Self-reported resilience, however, may counteract the influence of parental ACEs on low acuity PED utilization and 72 hour return rates.