Predicting time to emergency department re-visits and inpatient hospitalization among adolescents who visited an emergency department for psychotic symptoms: a retrospective cohort study

Abstract

BackgroundAdolescents experiencing psychosis may enter the mental health system by a pathway to care that includes or is initiated at the emergency department (ED). However, a better understanding of the pathway to care involving EDs is required to ensure these patients receive the care they require. This study explores physician-based care factors associated with adolescent ED re-visits and inpatient hospitalization following an index ED visit for psychotic symptoms.MethodsUsing administrative data from Alberta, Canada, we identified a cohort of adolescents aged 13–17 years who were discharged after an ED visit for psychotic symptoms between April 1, 2002 and September 29, 2010. Multivariable models estimated times to ED re-visit and inpatient hospitalization for mental health care in a 90-day period after ED discharge.ResultsThe cohort was comprised of 208 adolescents. Reduced times to ED re-visit and inpatient hospitalization were associated with: 1) multiple physician visits after discharge (ED re-visit: hazard ratio [HR] 5.93, 95 % confidence interval [CI] 2.09–16.82; inpatient hospitalization: HR 9.43, 95 % CI 1.24–72.00), and 2) post-ED physician care provided in a hospital-based outpatient clinic (ED re-visit: HR 3.07, 95 % CI 1.77–5.29; inpatient hospitalization: HR 3.48, 95 % CI 1.54–7.88). A follow-up visit to a pediatrician, compared to other physician specialties, was associated with earlier inpatient hospitalization (HR 4.45, 95 % CI 1.43–13.87). There was a significant interaction between sex and First Nations status in both models. Females with First Nations status re-visited the ED sooner (HR 3.19; 95 % CI 1.41–7.22) and were hospitalized sooner (HR 4.18; 95 % CI 1.24–14.06).ConclusionsThis study identifies predictors of time to care for adolescents with psychotic symptoms that are worthy of additional investigation. To ensure the pathway to care for these adolescents reduces the duration of untreated problems, health care aspects that require urgent investigation include the type assessments and clinical decisions made during post-ED physician visits.

Terminology and assessment tools of psychosis: A systematic narrative review

“…They defined psychotic symptoms as ‘perceiving things that are not there and holding unfounded, bizarre beliefs (hallucinations and delusions, respectively)’ . One study among many that defined psychotic symptoms as hallucinations or delusions argued that while psychotic symptoms are prevalent among adolescents, early detection before meeting psychotic disorder criteria is key for prevention . Interestingly, the authors stated that psychotic experiences are ‘a collective term for experiences involving psychotic symptoms’.…”

“…Instead of an explicit definition, authors often defined the term using examples. Psychotic symptoms are most frequently hallucinations and delusions or more specifically, auditory hallucinations and delusions . Others only directly referred to delusions or hallucinations .…”

Acute health care among Indigenous patients in Canada: a scoping review

“…One article found no difference in hospitalisation rates for cancer-related complications [81]. For mental health issues, five articles presented increased hospitalisation rates [32,[82][83][84][85]]. Carrière's article showed increased hospitalisation rates for all mental illnesses except for personality disorders [82] and Soleimani's article mentioned increased hospitalisation rates for women but decreased rates for men [85].…”

“…For mental health issues, five articles presented increased hospitalisation rates [32,[82][83][84][85]]. Carrière's article showed increased hospitalisation rates for all mental illnesses except for personality disorders [82] and Soleimani's article mentioned increased hospitalisation rates for women but decreased rates for men [85]. Articles about paediatric-related illnesses concluded to increased hospitalisation rates for acute otitis media [86], as well as for infections, congenital anomalies, respiratory, cutaneous, neurological and endocrine diseases and found no difference in hospitalisation rates for other health problems [87].…”