PC3055: A Single-center Approach to Screening of Adverse Childhood Experiences in the Pediatric Intensive Care Unit

Background: The purpose of this study is to determine whether Adverse Childhood Experiences (ACEs) can be assessed in the PICU utilizing a screening tool, the PEdiatric ACEs and Related Life-events Screener (PEARLS) (Koita et al., 2018). This survey consists of de-identified questions which ask about exposures that increase risk for toxic stress and negative health outcomes. The association between ACEs and severity of illness/outcomes in the PICU was analyzed as well as comfort level completing the survey.

We hypothesized that children in the PICU can be adequately screened for ACEs using the de-identified PEARLS tool with at least a 70% response rate.

Methods: Institutional Review Board approval was obtained prior to initiating the study. We enrolled all patients 3 months to 17 years admitted to the PICU for at least 24 hours. Consent/assent was obtained in-person or remotely. Those who did not consent were asked for the reason and their response was recorded. The PEARLS tool and demographic questionnaire were completed by a parent or caregiver. The data was analyzed with SPSS(IBM)® 27 and presented as mean (SD). Ordinary regression analysis was used to identify the relationship of the reported comfort level vs. number of ACEs. A p-value < 0.05 was considered significant in this analysis.

Results: Of 17 patient caregivers approached, 13 consented to the study. The response rate was 76% (95% CI 53-90).

The average age of the 13 included patients was 8.5 years. 69% were classified as “Caucasian”, 15% "African American", and 15% “Other”. Of those enrolled, 62% were male and 38% female. The majority of patients were admitted for neurological (31%) or respiratory diagnoses (31%). Trauma-related admissions constituted 15% of the consented population.

There was a statistically significant (OR 1.29, 95% CI 0.13-2.45, p=0.03) association of increased comfort with those who had a higher reported number of ACEs.

Conclusion: We have a higher-than-expected response rate to the PEARLS in our PICU with a significant level of comfort in answering questions related to ACEs. We envision this will be a step towards prevention and early intervention for family-centered and trauma-informed care. Our data will provide information on the need for advocacy and resource allocation for patients and families. These interventions are important not only for treating the patient while they are in the ICU, but also for addressing any ACEs which may serve as a predisposition for re-admission. We hope to bring awareness to the hardships that our patient population faces and how they influence ICU survivorship; to discover ways to decrease the prevalence of ACEs in general; and to create methods by which we can address these ACEs during ICU admission in order to prevent complications and the perpetuation of long-term medical challenges.