Assessment of tobacco smoke exposure in the pediatric emergency department

Objective: Tobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics. Methods: This retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child's tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status. Results: A total of 116,084 children were included in the analysis. Mean child age was 6.20 years (SD ± 5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened. Conclusion: Despite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.