The Utility of a Travel Screen at Triage in Pediatric Emergency Medicine.

BACKGROUND: The travel screen was implemented by emergency departments (EDs) across the country in 2014 to detect patients exposed to Ebola early and prevent local outbreaks. It remains part of the triage protocol in many EDs to detect communicable disease from abroad and has become a defacto screen for other travel-related illness. Its utility has not been studied in the pediatric ED. METHODS: This was a retrospective review of electronic medical records across 3 EDs from January 1, 2016, to December 31, 2016. The screening question reads, "Has the child or a close contact of the child traveled outside the United States in the past 21 days?" A follow-up question requesting travel details is included for positive screens. We compared length of stay, return-visit rates, and differences in disposition between patients with positive and negative travel screens using generalized linear regression. Matched regression estimates, 95% confidence intervals, and P values were reported. RESULTS: The study population included 152,945 patients with a total of 322,229 encounters in 2016, of which 232,787 encounters had a travel screen documented during triage. There were 2258 patient encounters that had positive travel screens. Only 201 (8.9%) of these encounters had further description of the travel in the comments box. The odds of hospital admission for patients with positive travel screens were 1.76 (95% confidence interval, 1.54-2.01; P < 0.001) times the odds of hospital admission for patients screened negative. The significance of this finding was largely driven by general hospital admission. Other metrics did not differ significantly between the groups. CONCLUSIONS: Although a positive travel screen was mildly predictive of inpatient admission, information is not available to providers about travel-related risk. Recent literature suggests integrating a travel history with presenting symptoms and region of travel and could produce a more specific travel screen. A revised travel screen should be implemented and studied in the pediatric ED.