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The relationship between adverse childhood experiences, the frequency and acuity of emergency department utilization and primary care engagement. Child Abuse Negl 2022 Feb;124:105479



Pubmed ID




Scopus ID

2-s2.0-85123585305 (requires institutional sign-in at Scopus site)   1 Citation


INTRODUCTION: A history of adverse child experiences (ACEs) is associated with increased high-risk adult behaviors, morbidity, mortality, and use of the emergency department. This study was designed to understand the relationship between ACEs and the characteristics of emergency department use and primary care engagement.

METHODS: An in-person survey was conducted at an academic emergency department (ED) assessing ACE score, emergency department utilization and acuity, and primary care engagement.

RESULTS: The prevalence of ACEs was 71.1% with 1+ ACE and 32.5% with 4+ ACE. ACE scores of four or more were associated with three or more ED visits in the past year compared those with an ACE score of zero (OR 3.22; p < 0.05) and when adjusted for sociodemographic factors (OR 3.22; p < 0.10). Higher ACE scores were associated with lower acuity presentations as indicated by the Emergency Severity Index before (ACE score 1 OR 3.91 p < 0.05; ACE score 2-3 OR 2.35 p < 0.05; ACE score 4+ OR 3.95 p < 0.05) and after adjustment (ACE score 1 OR 3.80 p < 0.10; ACE 2-3 OR 3.50 p < 0.10; ACE 4+ OR 4.36 p < 0.05). There was no association between ACE score and having a primary care provider (PCP), frequency of PCP visits, or PCP rating.

CONCLUSION: Higher ACE scores were associated with higher emergency department utilization and lower acuity presentations but not associated with levels of primary care engagement. Additional investigations are needed to adequately characterize the discrete causal mechanisms behind these current findings.

Author List

Diaz R, Walker RJ, Lu K, Weston BW, Young N, Fumo N, Hilgeman B


Brian Hilgeman MD Associate Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
Benjamin Weston MD, MPH Associate Professor in the Emergency Medicine department at Medical College of Wisconsin
Nicholas D. Young PhD Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Emergency Service, Hospital
Primary Health Care