1 Youth Experiencing Homelessness Presenting to an Urban Paediatric Emergency Department: A Descriptive Study
Notice bibliographique
Résumé
Abstract Background Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns. This population faces multiple barriers in accessing care, resulting in unaddressed needs and reliance on Emergency Departments (ED). In Canada, the use of the paediatric ED by YEH has not been well described, and there is no data exploring the effects of the COVID-19 pandemic lockdown on ED attendance by this population. Objectives This study aims: 1) To review the frequency/nature of the presentations to the paediatric ED by YEH; 2) To compare pre- and post-COVID-19 data. Design/Methods Medical records were searched for ED encounters where a patient identified a youth shelter as their address and/or had terms documented such as “homeless”, during two time periods: pre-COVID-19 (May 1, 2018–March 15, 2020) and post-COVID-19 lockdown (March 16, 2021–Jan 31, 2022). Pertinent details of the encounters were documented, including chief complaint (CC). Descriptive statistics were used, as well as comparative analysis of the two time periods. Results A total of 1103 encounters were included. Over the total 45-month study time period, CCs were split between mental health-related (n=562, 50.9%) and physical health-related presentations (n=541, 49%). Of the mental health CCs, 396 (70.4%) were documented as “depression/overdose/suicidal/self-harm”. The most common CCs related to physical health were injuries (n=127, 23.4%), and pain (n=126, 23.2%). YEH most commonly attended the paediatric ED between 17:00-00:00 (n=504, 45%), and were triaged as CTAS 3/urgent (n = 676, 61.2%). Of those who completed an Ask Suicide-Screening Questionnaire (ASQ) (n=303), 45.8% (n=139) had an acute positive screen/imminent risk identified. The most common principal diagnoses documented at disposition were related to injuries/assault/pain (n= 224, 20%), and suicide attempt/self-harm (n=196, 17.7%). Of the 166 outpatient referrals made at discharge from ED, 105 (63%) were to mental health/psychiatry. While overall there were fewer ED encounters for this population “post COVID-lockdown” (n=465) as compared to “pre-COVID” (n=638) (p-value <0.05), there was a significant reduction in mental health-related CCs (pre-COVID n=365, post-COVID n=197; p-value <0.05), with no significant reduction in physical-related CCs after the pandemic lockdown (pre-COVID, n=273, n=268). Conclusion YEH utilize the paediatric ED for both their mental and physical healthcare and frequently report suicide risk. The findings that lower attendance to the paediatric ED for mental health-related concerns followed the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care or novel methods of mental health care delivery post-pandemic.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».