597 - Variations in Follow-up Care for Children Presenting to the Emergency Department for Headache: A Multi-Center Prospective Cohort Study

Publication Number: 1574.597

Jeanine E. Hall, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kaileen Jafari, University of Washington School of Medicine, Seattle, WA, United States; Pamela J.. Okada, University of Texas Southwestern Medical School, Dallas, TX, United States; My H. Vu, Children's Hospital Los Angeles, Los Angeles, CA, United States; Peter Dayan, Columbia University, Hastings on Hudson, NY, United States; Nathan Kuppermann, Children's National Health System, Washington, DC, United States; Tamara D.. Simon, Children's Hospital Los Angeles, Los Angeles, CA, United States; Todd Chang, Children's Hospital Los Angeles, Los Angeles, CA, United States; Eileen Klein, Seattle Children's, Seattle, WA, United States; Daniel S. Tsze, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Follow-up care of emergency department (ED) pediatric visits for headaches enable ongoing management. In general, publicly insured children have lower rates of follow-up to receive specialty care. Few studies explore follow-up for children with headaches after an ED visit.

Objective: To determine if insurance status or race/ethnicity are independently associated with the time to and rate of recommended primary care provider or a neurologist follow-up.

Design/Methods: This was a 4-center prospective study in the Pediatric Emergency Care Applied Research Network (PECARN) of caregivers of children with headaches seen in the ED and discharged home with no neuroimaging at the time of ED visit (2022-2024). Caregivers were surveyed for follow-up data every month up to 6 months to track outcomes: follow-up appointments. Chart reviews corroborated clinic visits. Between group differences in time to follow-up were characterized using Kaplan-Meier curves.

Results: Of 288 eligible participants, 140 caregivers completed some portion of, while 120 completed all follow-up questionnaires. The median age of children with headache was 12.8 years. Participants (N = 283) were predominantly Hispanic or Latino (61%), with 16% Black or African American and 15% White (both not Hispanic or Latino); 85% were classified as minoritized. English proficiency was present in 78%. The majority of patients had public insurance (71%, Table 1). Among the 120 caregivers with complete responses, 77% reported that the ED clinician recommended follow up with a PCP and 49% with a neurologist.

Median time to first PCP appointment after index ED visit for headache was 3 weeks, with no differences based on age (log rank p=0.41), insurance (p=0.23), or race/ethnicity (p=0.52), however children from households with below‑median income experienced significantly longer time to follow‑up (log rank p=0.0077, Figure 1).

Median time to first neurology follow-up appointment after the index ED visit for headache was 6 weeks. While this did not vary by age (p=0.22), income (0.52), or insurance (0.44), racially and ethnically minoritized children experienced significantly longer time to appointment (log-rank p=0.0057,Figure 2).

Conclusion(s): Less than half of children with headaches discharged home from pediatric EDs had outpatient follow-up despite ED clinician recommendations. Time to PCP follow-up was longer for children with lower household incomes. Time to neurology follow-up was longer for racial/ethnical minoritized backgrounds. These findings support the need for tailored interventions to improve equitable post-ED outpatient care connections.

Table 1: Study Participant Demographics and Characteristics


Figure 1: Kaplan-Meier Curves Showing Time to Primary Care Follow-up After ED Visit for Headache Comparing Age, Household Income, Insurance Type, and Race/Ethnicity Categories


Figure 2: Kaplan-Meier Curves Showing Time to Neurology Follow-up After ED Visit for Headache Comparing Age, Household Income, Insurance Type, and Race/Ethnicity Categories