1.63 Presentation of Children and Adolescents to US Emergency Departments for Alcohol and Substance Use Pre–and Post–COVID-19

The objective of this presentation is to describe the effect of COVID-19 on presentation to emergency departments (EDs) across the United States for pediatric alcohol and substance use with attention to racial and ethnic differences. Data were extracted from Epic’s Cosmos environment, which is a limited data set using de-identified electronic health record (EHR) data from more than 193 million patients across 50 states, representing 7.7 billion encounters from 1185 hospitals. The data were extracted as of July 10, 2023. The total sample of pediatric patient encounters to EDs was 18,260,795, of which 131,109 had billing or encounter diagnoses of alcohol or substance disorder as defined by ICD codes F10-F19 for their ED encounter. Extraction included all encounters from 3/13/2018 to 3/13/2023. Pre–COVID-19 was defined as calendar years 2018 and 2019, and COVID-19 was defined as 2020, 2021, and 2022. Diagnoses in Epic were included if they were specified as encounter diagnoses, billing or admission final diagnoses, admitting diagnoses, or discharge diagnoses during these years. These were then explored by year to obtain descriptive estimates involving race and ethnicity. Although overall ED visits among youth dropped during COVID-19, ED encounters associated with substance use increased over the time period observed. Within each racial and ethnic group examined, the proportion of ED encounters that comprised substance use ICD-10 codes rose every year. White participants with encounters involving substance use increased from 0.14% pre–COVID-19 to 1.50% during COVID-19, whereas Black participants increased respectively from 0.11% to 1.03% and Hispanic participants increased from 0.09% to 1.02%. ED visits related to adolescent substance use increased during COVID-19. Our results show that non-Hispanic White patients had the highest rates of substance-related ED visits among minors, although proportions increased across all years for all racial and ethnic groups. The results may underscore the impact of pandemic-related stressors on adolescents, contributing to a subsequent mental health crisis characterized by an elevated prevalence of substance use.