Abstract 478 Poster Session III, Monday, 5/3 (poster 229)

Introduction: The association of socioeconomic status (SES) with severity of illness in the pediatric population is not clear. We hypothesized that pediatric patients from families of lower SES will present to the emergency department (ED) more severely ill than patients from families of higher SES.

Methods: Setting: This study was performed at Children's National Medical Center, an urban, university-affiliated, tertiary care, pediatric hospital. Participants: Patient records were reviewed as a Non-concurrent cohort from the four month period September through December 1994. Data: Patient severity of illness was quantified using a Predicted Risk of Admission (PRISA) score, a validated assessment of emergency room department severity of illness. The PRISA score gives an estimate of the probability of hospital admission based on physiologic and historical data. Patient socioeconomic status was described using health insurance status (abstracted directly from the ED data base) and characteristics obtained from the United States 1990 Census of Population and Housing. These characteristics included household education level, poverty classification, and occupation.

Results: There were 1,869 patients included in this study. 279 (14.9%) patients were admitted to the hospital and 29 (1.6%) were admitted to the intensive care unit. The mean age was 64.4 months. The patients population consisted of 44% females, 88.2% African Americans, 4.2% Caucasians, and 5.7% Hispanics. Patients with Medicaid insurance had significantly higher PRISA scores (p=0.0091) than patients with either private insurance or no insurance. Patients characterized as impoverished according to their federal poverty line status has significantly higher PRISA scores than their wealthier cohorts (p=0.0365). The association of PRISA with educational status and occupation were not statistically significant.

Conclusion: Children with low socioeconomic status, who present to the emergency department for evaluation and treatment of their urgent needs, have a greater severity of illness than children with higher socioeconomic status.