Hatice Ezgi Baris1, Nicel Yildiz Silahli2, Nuriye Ayca Gul2, Lubna Qutranji2, Jeffrey Goldhagen3, Perran Boran2. 1. School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey. ezgi_aksu@yahoo.com. 2. School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey. 3. Division of Community and Societal Pediatrics, University of FL College of Medicine-Jacksonville, Jacksonville, FL, USA.
Abstract
Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Electronic medical records of Syrian refugee children ≤ 18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children.The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p < 0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p < 0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p < 0.001). The median age (and interquartile range - IQR) was lower in hospitalized refugee than in resident children [12 (0-83) months vs 41 (8-111) months, p < 0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p = 0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p < 0.001). The median NICU stay was longer in refugees [6 (IQR 4-17) days vs 3 (IQR 1-9) days, p < 0.001]. CONCLUSION: Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes. WHAT IS KNOWN: • Children are the most affected victims of armed conflicts in terms of health outcomes. • Refugees prefer to access healthcare through the emergency department. WHAT IS NEW: • Refugee children were more likely to present as urgent when compared to resident children. • Admission to neonatal and intensive care units was more frequent among refugee than resident children.
Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Electronic medical records of Syrian refugee children ≤ 18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children.The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p < 0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p < 0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p < 0.001). The median age (and interquartile range - IQR) was lower in hospitalized refugee than in resident children [12 (0-83) months vs 41 (8-111) months, p < 0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p = 0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p < 0.001). The median NICU stay was longer in refugees [6 (IQR 4-17) days vs 3 (IQR 1-9) days, p < 0.001]. CONCLUSION: Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes. WHAT IS KNOWN: • Children are the most affected victims of armed conflicts in terms of health outcomes. • Refugees prefer to access healthcare through the emergency department. WHAT IS NEW: • Refugee children were more likely to present as urgent when compared to resident children. • Admission to neonatal and intensive care units was more frequent among refugee than resident children.