A Descriptive Analysis

Abstract

Objectives Infants presenting to pediatric emergency departments (EDs) after a choking episode, cyanotic event, or irregular breathing pattern are often diagnosed with a brief, resolved, unexplained event (BRUE). Social determinants of health may affect these patients; therefore, we aimed to define population demographics and determine significant demographic predictors between 2 cohorts—infants presenting with BRUE, and those admitted to the intensive care unit. Methods Using data from the Pediatric Health Information System (Children's Hospital Association, Washington, DC, Lenexa, KS), this multicenter, retrospective study included children aged 0–1 year from 52 hospitals who presented with an International Classification of Diseases-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE) between January 1, 2016, and June 30, 2021. Cohort 1 patients presented to the ED with BRUE; cohort 2 patients were admitted from the ED for BRUE. Univariate and multivariate logistic regression were performed for both cohorts to discover possible demographic predictors. Results Overall, 24,027 patients were evaluated. Patient sex did not affect admission rates (odds ratio [OR] = 1.034; 95% confidence interval [CI], 0.982–1.089; P = 0.2051). Black race (OR = 1.252; 95% CI, 1.177–1.332; P < 0.0001) and Medicaid insurance (OR = 1.126; 95% CI, 1.065–1.19; P < 0.0001) were significantly associated with an increased risk of admission. “Other” race (OR = 0.837; 95% CI, 0.777–0.902; P < 0.0001) and commercial insurance were significantly associated with a greater likelihood of discharge (OR = 0.888; 95% CI, 0.84–0.939; P < 0.0001). Conclusions Black race and Medicaid insurance predicted admission in this patient population, but demographics did not play a role in intensive care unit admission overall. Social determinants of health and demographics therefore appeared to play a role in admission for patients presenting to the ED. Future research could evaluate the effect of focused interventions, such as providing additional resources to socially at-risk families through community outreach, on admission rates of patients with these specific at-risk demographics.