[Family socioeconomic deprivation and vulnerability in the pediatric emergency room: evaluation and management]

Developing and Validating an Individual-Level Deprivation Index for Children's Health in France

BACKGROUND

Deprivation generates many health inequalities. This has to be taken in account to enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health.

METHODS

The French Individual Child Deprivation Index (FrenChILD-Index) was designed in four phases: item generation then reduction using the literature review and expert opinions, and index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, concordance with a blinded evaluation by an expert enabled us to determine thresholds for two levels of moderate and severe deprivation.

RESULTS

The generation and reduction phases retained 13 items. These were administered to 986 children for the derivation and validation phases. In the validation phase, the final 12 items of the FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children) a sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care), the sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9].

CONCLUSIONS

The FrenChILD-Index is the first pediatric individual-level index of deprivation validated in Europe. It enables clinical practice to address the social determinants of health and meet public health goals.

Children with poor access to healthcare in emergencies: standpoint and practices of pediatricians in France

Many children with poor access to healthcare are finally admitted in emergency departments. This study describes the knowledge, attitudes, and practice of 161 pediatricians caring for these children. Among the pediatricians, 84 (52.8%) felt under-informed about the performance of the various health insurances, 107 (68.6%) lacked systematic information on the health insurance cover of the children they cared for, and many were unaware of appropriate local resources. Admission to emergency departments can be a way of linking up the healthcare pathway, once provided: systematic assessment of children's access to healthcare, better information and coordination of healthcare professionals' interventions, and several partnerships including social support.