110 Differences in Pediatric Visits to Emergency and Pediatric Emergency Departments are Linked to Socioeconomic Status

In large urban centers with tertiary level hospital systems, families have the choice to bring their children to pediatric emergency departments (PEDs) or general emergency departments (GEDs). Many factors influence this decision, including the availability of specialty care and geographic convenience. However, barriers to accessing care, such as cost of transportation, lack of primary care and lower education may disproportionately affect those of lower socioeconomic status (SES), which further disadvantages a population that experiences poorer health outcomes as a result. Planning and delivery of pediatric acute care should be informed by how low SES families use emergency care but this is still unknown. The primary objective of this study was to determine if there were differences between pediatrics patients that visited a pediatric emergency department (PED) versus a general emergency department (GED), when both were available in the same city. It was hypothesized that pediatric patients with lower socioeconomic status would be less likely to access pediatric emergency care, instead prioritizing geographic convenience. A retrospective chart review was conducted of all pediatric visits to general emergency departments (GEDs) in a large tertiary level hospital system which included a pediatric emergency department (PED). A period of 6 months from January to June, 2015 was chosen in order to capture the seasonal variation of pediatric visits. A randomly sampled population of comparable visits to the local PED was then used to compare key demographic and medical characteristics, including age and gender, postal code, acuity at presentation (as measured by the Canadian Triage and Acuity Scale), chief complaints and time of registration. Postal code data was gathered in order to determine socioeconomic status, which had been determined prior in a local study examining geographic distribution of poverty in the city. A total of 4053 pediatric visits were documented to the 3 urban GEDs over the 6 month study period. A random sample of the same number of patients that visited the PED over the same study period was used as a comparator. When compared to children going to GEDs, children at the PED were more likely to be younger in age. Infants under the age of 1 year made up 29% of PED visits, compared to 10.7%/8.9%/11.1% at the other 3 sites. This trend was similar in children aged 2–4. Children represented a smaller proportion of overnight visits in the PED when compared to children visiting the GED (9.4% vs. 15.5%/12.8%/14.5%). Acuity, as measured by the Canadian Triage and Acuity Scale (CTAS), differed only at the downtown GED when compared with the PED (CTAS 1 1.7% vs. 0.6%). Types of chief complaints appeared to be equally represented across all GEDs and the PED. When postal codes were mapped to locations of hospitals, it appeared that GEDs tended to draw from their immediate local vicinity, whereas the PED showed a much more distributed patient base. This data also suggests that higher SES families present to the PED whereas lower SES patients stay at their local hospitals. Children presenting to the PED tended to be younger, represent a potential perception that young children require specialty care. The trend of the most acutely ill patients being overly represented at the downtown GED may relate to this population being of low SES with poorer health outcomes. The PED catchment area appears to correlate with higher SES populations, which may be related to access to transportation or awareness of specialist availability. These findings have implications for planning and delivery of pediatric acute care.

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