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Aim To describe a cohort of patients aged 7–17 years presenting with mental health (MH) problems to an Australian tertiary paediatric emergency department (ED), in order to identify: (i) predictors of admission; and (ii) prolonged length of stay (LOS); (iii) reasons for ED presentation based on diagnosis and (iv) differences between major diagnostic groups. Methods Data for all presentations from 1 January 2018 to 31 December 2018 were extracted and analysed from the hospital's electronic medical record system. MH presentations were identified though rule‐based coding and manual file review. Results In this 12‐month period, 1071 children had 1690 emergency MH presentations constituting 6.7% of all ED presentations for children aged 7–17 years. Collectively, the leading cause for presentations was suicidal ideation, self‐harm or drug overdose (55%). Compared to discharged patients, admitted patients were more likely to be female (odds ratio (OR) 1.82, confidence interval (CI) 1.41–2.35), aged over 14–years (OR 2.50, CI 1.98–3.15), triaged with high acuity (OR 2.70, CI 2.00–3.65) and arrive by ambulance or police (OR 1.31, CI 1.04–1.64). The highest risk diagnosis associated with admission was eating disorders (OR 9.19, CI 5.48–15.40). Patients with a prolonged LOS (>8 h) were more likely to need admission (OR 5.38, CI 3.81–7.61) and be diagnosed with drug overdose (OR 2.39, CI 1.51–3.80) or acute behavioural disturbance (OR 1.61, CI 1.09–2.39). Conclusion Mental health presentations constitute a large proportion of ED presentations. Suicidal behaviour and self‐harm account for half of them. We have identified patients at increased risk of admission and prolonged ED LOS.

Aim To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). Methods Retrospective review of all ED MH presentations in children aged 7–17 years, presenting over a 12‐month period from the 1st of January 2018 to the 31st of December 2018, to the Royal Children's Hospital in Melbourne, Australia. Univariate analyses were carried out to examine the relationship between an underlying diagnosis of ASD and/or ADHD and a number of key presentation variables. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for ED management outcomes. Results There were 374 presentations in this cohort, representing 28% of the total MH presentations in 2018. The most common reason for presentation was acute severe behavioural disturbance. Young people with ASD and ADHD were at increased risk of having an acute crisis team response activated (ASD RR 2.3, CI 1.6–3.3, ADHD RR 2.2, CI 1.2–4.1). Compared to those without either diagnosis, young people with ASD were more likely to be physically restrained (RR 2.8, CI 1.7–4.6), managed in seclusion (RR 3.3, CI 1.7–6.4) and to receive medication to assist with behavioural de‐escalation (RR 2.8, CI 1.6–4.9). Conclusions Children with ASD and/or ADHD represent one‐quarter of all children presenting to the ED with MH complaints. They experience high rates of acute severe behavioural disturbance. Future research is needed to co‐design, implement and evaluate better approaches for their management.

Objective There is paucity of evidence for psychotropic medication use in children and adolescents presenting with mental health (MH) problems to the ED. We set out to describe paediatric psychotropic medication use in the ED. Methods We conducted a retrospective electronic medical record review of ED patients with MH discharge codes at a tertiary paediatric ED in 2018. We assessed the epidemiology and management of patients who received a psychotropic medication. We calculated the odds ratios (ORs with 95% confidence intervals [CIs]) of key demographic factors of medicated versus non‐medicated MH patients. Results During 2018 there were 1695 MH‐related presentations to the ED. Of these, 280 presentations resulted in the patient receiving a psychotropic medication (16.5%). Medicated children with MH illness were more likely to be male (OR 1.50, 95% CI 1.16–1.96), have a more acute triage category (OR 3.37, 95% CI 2.28–4.98), have an ED length of stay greater than 12 h (OR 3.96, 95% CI 2.56–6.13) and present after hours (OR 1.51, 95% CI 1.16–1.96). Most had a diagnosis of acute behavioural disturbance or suicidal ideation. A variety of treatment regimens were used but children primarily received a single oral agent (diazepam or olanzapine). Parenteral medications were given in 8.6%. No adverse events were recorded. Conclusion A minority of children with MH presentations to the ED were medicated. It will require multicentre research to determine the most effective and safe acute psychotropic agents for oral and parenteral use in children in the ED.