(1036) Social Vulnerability Index as a Predictor for Emergency Department Utilization Among Pediatric Tracheostomy Patients

Introduction: Children with tracheostomies are medically complex and frequently present to the emergency department (ED). Studies show social vulnerability is associated with higher ED utilization, but the association specific to children with tracheostomies remains unclear. This study investigates how the social vulnerability index (SVI) predicts ED utilization among pediatric tracheostomy patients.

Methods: We conducted a retrospective analysis and chart review of pediatric tracheostomy patients treated at a single tertiary care center between March 2007 and November 2025. SVI and four subdomains (socioeconomic status, household characteristics, racial & ethnic minority status, and housing type & transportation) were calculated in accordance with CDC methodology. Outcome measures of tracheostomy-related ED visits were divided into subcategories: wound issues, respiratory issues, accidental decannulation, sepsis or ACLS, and equipment failure.

Results: 664 ED visits from 104 pediatric tracheostomy patients were included. Overall SVI was associated with higher total ED visits (p < 0.05) and hospital admissions (p < 0.05); however subdomains of SVI did not show statistical significance as predictors of ED utilization. Ventilator dependence (p < 0.01), epilepsy (p < 0.05), sleep disorders (p < 0.05), chromosomal abnormalities (p < 0.02), asthma (p < 0.05), developmental delays (p < 0.01), gastrointestinal conditions (p < 0.05) were associated with both higher total and ED visits per year.

Conclusions: These findings suggest SVI may play a role in ED utilization, but medical complexity appears to be a stronger predictor. These factors should be considered for improving tracheostomy outcomes and ED utilization.