ABSTRACT
BACKGROUND: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents' ACEs and resilience may be associated with their children's health outcomes. OBJECTIVE: To determine the association of parental ACEs and resilience with their child's risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE: Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES: Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS: In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% CI, 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION: Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.
Subject(s)
Adverse Childhood Experiences , Adult , Child , Delivery of Health Care , Family , Humans , Parents , Prospective StudiesABSTRACT
BACKGROUND: End-tidal carbon dioxide (EtCO2) measurement has been shown to have prognostic value in acute trauma. OBJECTIVE: Evaluate the association of prehospital EtCO2 and in-hospital mortality in trauma patients and to assess its prognostic value when compared to traditional vital signs. METHODS: Retrospective, cross-sectional study of patients transported by a single EMS agency to a level one trauma center. We evaluated initial out-of-hospital vital signs documented by EMS personnel including EtCO2, respiratory rate (RR), systolic BP (SBP), diastolic BP (DBP), pulse (P), and oxygen saturation (O2) and hospital data. The main outcome measure was mortality. RESULTS: 135 trauma patients were included; 9 (7%) did not survive. The mean age of patients was 40 (SD17) [Range 16-89], 97 (72%) were male, 76 (56%) were admitted to the hospital and 15 (11%) went to the ICU. The mean EtCO2 level was 18 mmHg (95%CI 9-28) [Range 5-41] in non-survivors compared to 34 mmHg (95%CI 32-35) [Range 11-51] in survivors. The area under the ROC curve (AUC) for EtCO2 in predicting mortality was 0.84 (0.67-1.00) (p = 0.001), RR was 0.82 (0.63-1.00), SBP was 0.72 (0.49-0.96), DBP was 0.72 (0.47-0.97), pulse was 0.51 (0.26-0.76), and O2 was 0.64 (0.37-0.91). Cut-off values at 30 mmHg yielded sensitivity = 89% (51-99), specificity = 68% (59-76), PPV = 13% (6-24) and NPV = 99% (93-100) for predicting mortality. There was no correlation between RR and EtCO2 (correlation 0.16; p = 0.06). CONCLUSION: We found an inverse association between prehospital EtCO2 and mortality. This has implications for improving triage and assisting EMS in directing patients to an appropriate trauma center.
