6.132 IDENTIFICATION AND ANALYSIS OF ADVERSE CHILDHOOD EXPERIENCES IN PEDIATRIC PATIENTS SEEN BY A CHILD AND ADOLESCENT PSYCHIATRIC CONSULT LIAISON SERVICE ON MEDICAL WARDS AND IN THE EMERGENCY DEPARTMENT

Objectives: Identify children who have experienced trauma, and the types of trauma experienced, using the 10-point Adverse Childhood Experience (ACE) scale in hospitalized pediatric patients on medical wards and in the emergency department (ED). Methods: All patients seen by a Child and Adolescent Psychiatric Consult/Liason service were asked 10 questions regarding traumatic events. Each question encompassed a different form of trauma; every "yes" response received 1 point. The total score (range = 0-10) was calculated for each patient and input into a secure document. Results: The majority of subjects (88.6%, N=123; 65 percent female, 35 percent male) had experienced 1 or more categories of adverse childhood experiences (ACE ≥1) and 42.3 percent had experienced 4 or more (ACE ≥4). The mean ACE score was 3.2 and the median was 3. Additionally, each ACE score above 0 increased patient risk of being admitted to either subacute or inpatient care by 19.7 percent (p = 0.025). Conclusions: Adverse childhood experiences have been identified as a risk factor for poor health outcomes. In 1998, Felitti et al. demonstrated that individuals with an ACE score greater than or equal to four had four- to 12-fold increased risk of developing alcoholism, drug abuse, and depression. In 2013, a review by Brosbe and Fraust concluded that growing up in a developmentally adverse environment was associated with longer hospitalizations, a greater number of diagnoses, and greater use of healthcare resources. While there are many studies regarding the prevalence and effects of early trauma, to our knowledge there have not been studies examining these issues for pediatric patients in a medical hospital or emergency department. Our data demonstrates a high prevalence of ACE scores in medically hospitalized pediatric patients with identified psychiatric illness. This underscores the importance of recognizing at-risk children, and developing more effective trauma-informed interventions for these children to help mitigate both medical and psychiatric sequlae of childhood trauma.