Smoke-exposed children often not identified by screening

Investigators sought to determine how often emergency department (ED) providers, pediatric residents, and nurses document screening for secondhand smoke (SHS) exposure, an important cause of mortality and morbidity among children. They also evaluated the accuracy of admission screenings for SHS exposure compared with a structured caregiver interview combined with objective cotinine levels.

The study was conducted at a children's hospital in upstate New York in 140 inpatient pediatric families who consented to a chart review, salivary cotinine measurement, and an in-person SHS exposure interview.

About 93% of the patients were screened for SHS exposure by at least 1 person. Overall, ED providers screened for SHS exposure 46% of the time, pediatric residents 42% of the time, and nurses 79% of the time, with providers, residents, and nurses reporting 18%, 38%, and 12% of patients exposed to SHS, respectively. However, the exposure measure combining parent report (via structured interview) of any exposure in the past 7 days or a cotinine level of more than 1 ng/mL used by investigators found that a larger proportion of children (46%) were exposed to smoke (Wilson KM, et al. Hosp Pediatr. 2012;2[1]:26-33).

Hospitalization represents a unique opportunity to intervene on SHS exposure, especially if the physician can show parents a link between smoke and the reason for the child's admission. Families may be more receptive to change during a crisis. And even during a brief hospitalization, hospital staff has much more extended contact with families than during a busy office visit. We need to ask the right questions about SHS exposure during every admission. And we need to be ready with information and advice on smoking cessation and preventing SHS exposure.

-Michael Burke, MD