Pediatric emergency department use by Afghan refugees at a temporary housing facility

Abstract

Objectives: In August 2021, "Operation Allies Welcome" evacuated 76,000 Afghan refugees to 8 US temporary housing facilities. The impact of refugee influx on local emergency department (ED) use and the resources needed during resettlement are poorly described. We report the frequency of pediatric ED visits and characterize the ED resources needed by pediatric Afghan refugees from 1 temporary housing facility. Methods: This single-center, retrospective cohort study identified participants via a refugee identifier in the medical record. The primary outcome was the frequency and timing of pediatric ED visits; secondary outcomes included resources used during ED evaluation and management. Trained reviewers collected data using a predefined instrument and descriptive statistics are reported. Results: This study included 175 pediatric ED visits by Afghan refugees. The highest volumes (n = 73, 42%) occurred 3-5 weeks after evacuation. Common presenting complaints included fever (36%), gastrointestinal (15%), and respiratory (13%). Resources used included radiography (64%), lab testing (63%), and medication (78%). Specialist consultation occurred in 43% of visits; infectious diseases (17%) and neurology (15%) were the most common. Discharge (61%) was more common than admission (39%), though 31% of discharged patients had a repeat ED visit. Only 51% attended a recommended follow-up appointment. Conclusion: In this study, most pediatric ED visits by refugees occurred within 5 weeks of arrival. Most patients were discharged after diagnostic testing, medication, and specialist consultation, but repeat ED visits were common. These patterns have important implications in preparing for future mass displacement events.