Challenges of Managing Pediatric Mental Health Crises in the Emergency Department

Chun, Thomas H.; Katz, Emily; Duffy, Susan; Gerson, Ruth

doi:10.1016/j.chc.2014.09.003

Cited by 50 publications

(55 citation statements)

References 63 publications

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“…10 Additionally, ED staff generally lack MH training and the availability of MH professionals is limited. 11 Declines in community MH resources for children and adolescents have made PEDs the "safety net" of a fragmented MH infrastructure. 12 Recently published Ontario population data show MH related ED visit rates have increased between 2006-2011 at a higher rate than outpatient visits.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Cloutier

Thibedeau

Barrowman

et al. 2016

CJEM

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ObjectivesDespite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits.MethodsWe examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression.ResultsA total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances.ConclusionsRepeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.

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Section: Introductionmentioning

confidence: 99%

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Cloutier

Thibedeau

Barrowman

et al. 2016

CJEM

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“…Este estudio contribuyó en explorar características locales, corroborando que, en concordancia con reportes internacionales, la heteroagresividad fue la principal causa de admisión (15,16) . Sin embargo, la presentación de síntomas psicóticos e irritabilidad fueron casi tan frecuentes como la conducta suicida.…”

Section: Discussionunclassified

Emergencias psiquiátricas en niños y adolescentes: Relación entre características clínicas y demográficas

2017

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Introducción. Actualmente, la presentación de cuadros agudos de trastornos psiquiátricos es habitual en niños y adolescentes. Objetivo. Determinar la relación entre variables clínicas y demográficas de niños y adolescentes atendidos por emergencia psiquiátrica. Diseño. Estudio cuantitativo, observacional, retrospectivo y analítico. Lugar. Hospital Hermilio Valdizán, Lima, Perú. Participantes. Pacientes menores de 18 años (N=285), de ambos sexos, atendidos durante el período setiembre 2014 - setiembre 2015. Intervenciones. Se recopiló información de historias clínicas, clasificándolas en variables clínicas y demográficas. El análisis univariado se realizó por distribución de frecuencias y el bivariado por pruebas chi cuadrado y exacta de Fisher. Resultados. El 13% de emergencias psiquiátricas fueron pediátricas. Fue más frecuente en el sexo femenino (60%), grupo etario de 12 a 17 años (93,3%) y procedencia Lima Este (73%). La edad media fue 14,8 (DE=2,1) años. Los motivos de emergencia más frecuentes fueron heteroagresividad (28,4%), alucinaciones (13,7%), irritabilidad (11,9%) y autoagresividad (10,9%). La ideación suicida (9,1%) estuvo asociada al sexo femenino OR 3,05 (IC-95%: 1,12-8,35; p=0,023). Las categorías diagnósticas más frecuentes fueron F20-F29 (31,6%), F30-F39 (25,6%) y F60-F69 (18,6%). El F30-F39 OR 2,31 (IC95%: 1,28 a 4,16; p=0,005) y F60-F69 OR 2,11 (IC95%: 1,09 a 4,10; p= 0,025) estuvieron asociados al sexo femenino. El 49% de los pacientes necesitó internamiento. Conclusiones. Existió aumento en prevalencia y menor edad de presentación al comparar con años previos. La heteroagresividad fue el motivo más frecuente de consulta. El sexo femenino tuvo mayor riesgo de Ideación suicida, trastornos del ánimo y personalidad. Se sugiere la elaboración de protocolos estandarizados y manejo especializado.

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“…A calm and quiet environment reduces stimulation, which can agitate these patients. Communication is guided by the carers who know the patient well and may use pictures or concrete actions . Referral to a paediatrician is important for diagnosis of the condition and medication to control behaviour.…”

Section: Children With Intellectual Disability or Autism Or Other Behmentioning

confidence: 99%

Managing adolescent behavioural and mental health problems in the Emergency Department

McCaskill

Durheim

2016

J Paediatrics Child Health

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Children and young people with behavioural issues frequently present to Emergency Departments. These are complex cases, often with a long preceding history. Caring for them requires a structured approach to ensure safety for the patient and all those involved. The HEADSS assessment is used as a framework. The Emergency Department focuses on treatment of the acute behavioural issues in the least restrictive manner possible. Ongoing behavioural issues are managed with referral to community and specialist resources.

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Challenges of Managing Pediatric Mental Health Crises in the Emergency Department

Cited by 50 publications

References 63 publications

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Emergencias psiquiátricas en niños y adolescentes: Relación entre características clínicas y demográficas

Managing adolescent behavioural and mental health problems in the Emergency Department

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