Objective Tobacco smoke exposure (TSE) causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend TSE screening at all pediatric clinical encounters. Data regarding TSE screening in the pediatric emergency department (PED) is sparse, although children with TSE-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of TSE screening in the PED, and assess associated sociodemographic/clinical characteristics. Methods This retrospective review included pediatric patients presenting to a large PED in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child’s TSE status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of TSE screening and TSE status. Results 116,084 children were included in the analysis. Mean child age was 6.20 years (SD ±5.6); 52% were male. Nearly half of children did not undergo TSE screening; only 60% of children with TSE-related illnesses were screened. Predictors of TSE screening were: younger age, male, African American, non-commercial insurance, high acuity, TSE-related diagnoses and non-intensive care admission. Of children screened for TSE, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance and TSE-related diagnoses. Non-African American children triaged as low acuity were more likely to have TSE, yet less likely to be screened. Conclusion Despite national recommendations, current TSE screening rates are low and fail to identify at risk children. PED visits for TSE-associated conditions are common, thus further research is needed to develop and assess standardized TSE screening tools/interventions in this setting.
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