EMERGENCY DEPARTMENT UTILIZATION BY TRANSGENDER AND GENDER NON-BINARY ADOLESCENTS

Purpose: Transgender and gender non-binary (TGNB) adolescents face unique challenges when seeking medical care, yet there is a paucity of literature exploring healthcare utilization by the TGNB population. Electronic medical records (EMR) have limited abilities to track sexual orientation and gender identity data, adding to the difficulty of studying this vulnerable population. This study evaluates emergency department (ED) utilization for TGNB adolescents with established access to primary care to understand reasons for seeking care. Methods: A retrospective chart review of visits for adolescent TGNB patients 12 to 26 years old who visited any ED in an urban, multihospital health system from January 2017 to December 2018 was performed. Patients were identified from enrollment lists of a primary care clinic serving TGNB adolescents. Data from the electronic medical record regarding patient demographics, medical/surgical history, ED clinical course, and discharge diagnoses was collected. Multiple visits were included in the analysis. Results: 477 adolescent patients belonging to the primary care clinic were screened for ED visits between January 2017 and December 2018. A total of 55 ED visits were made by 28 unique patients (6%). 14 patients made 1 visit (50%), 7 made 2 visits (25%), 2 made 3 visits (7%), and 5 made greater than 4 visits (18%). Patients were under 18 years of age for 22 of the 55 visits (40%). Reviewing dispositions, 22 (40%) visits resulted in at least one psychiatric or social discharge diagnosis, 9 of which occurred in patients under age 18 (41%). 11 (20%) visits resulted in at least one trauma discharge diagnosis, 4 of which occurred in patients under age 18 (40%). The discharge diagnoses for the remaining ED visits revealed 19 medical visits (35%), 1 surgical visit (1.8%), 2 other visits (3.6%), and notably 1 post-gender affirmation surgery visit (1.8%). 6 of the visits with psychiatric or social diagnoses and 3 of the visits with medical diagnoses led to a hospital admission. Conclusions: Our experience as a large academic health system that provides primary care to TGNB patients in a metropolitan area demonstrates a significant number of ED visits related to mental health and trauma. Additionally, a significant number of patients seen for psychiatric reasons required hospital admission. Half of the patients evaluated had multiple ED visits during this period. These findings suggest that there are opportunities to provide direct inter