Emergency department utilization and determinants of use by 0- to 6-year-old children with disabilities in Taipei.
Nearly one in three preschoolers with disabilities in Taipei used the ER within four months, and poverty was the clearest warning sign.
01Research in Context
What this study did
The team asked 1,000 Taipei families who had a child with any disability.
They wanted to know how many kids had gone to the emergency room in the last four months and why.
Parents filled out a short survey about the child’s health, money problems, and the ER visit.
What they found
Three out of every ten kids had already visited the ER once in just four months.
Fever and breathing trouble were the top two reasons parents gave.
Children from poorer homes and kids in worse overall health had the highest odds of going.
How this fits with other research
Tsai et al. (2012) looked at the same age group and found only 38 % ever got preventive check-ups.
Together the two papers show the same poor families miss routine care yet still land in the ER.
Chiang et al. (2013) widened the lens nationwide and found kids with intellectual disabilities average 20 outpatient visits a year.
That sounds like a contradiction—lots of clinic visits but still high ER use—but the earlier study counted all kids with disabilities while Po-Huang focused only on intellectual disability, a group that needs more care overall.
Why it matters
If you serve Taiwanese families, screen for money trouble at intake. A quick question about household income can flag kids at risk for repeated ER trips. Offer same-day nurse calls or weekend fever clinics so parents have an option before heading to the hospital.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add one question about household income to your intake form and flag low-income families for priority nurse hotline access.
02At a glance
03Original abstract
Although many studies have explored emergency services for children, there are few published reports of the utilization of emergency services by children with disabilities. The present study attempts to provide data regarding the utilization of, and factors affecting, emergency department visits by disabled children in Taipei. A general census of 1006 children with disabilities, identified from the Taiwan National Disability Registry System in Taipei, was conducted. The overall response rate was 38%, yielding a sample of 340 disabled children. The results showed that 30.1% of children with disabilities had utilized emergency department services over the past 4 months with an average of 1.4 visits per child. The most common reasons for emergency visits were fever (34.7%), respiratory symptoms (24.2%), abdominal pain (15.8%), injury (7.4%), and epilepsy seizures (7.4%). This study also found, using a logistic regression model, that emergency department utilization may be associated with household economic status and the reported physical health of children with disabilities. The 'deficit' and 'balance' household economic status groups gave odds ratios of 3.902 (95% CI=1.469-10.364) and 3.311 (95% CI=1.249-8.779), relative to the 'surplus' group. The model also indicated that those children with disabilities who were reported as being in poor physical health had 11.359 times (95% CI=2.968-43.469) the likelihood of using emergency care than those whose physical health was in excellent condition. The study suggests that in order to maximize the health of children with disabilities, medical care stakeholders should consider who are the most likely groups to use emergency department services and develop anticipatory guidance or preventive services for this vulnerable population.
Research in developmental disabilities, 2009 · doi:10.1016/j.ridd.2008.10.011