Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit

Cutler, Gretchen J.; Rodean, Jonathan; Zima, Bonnie T.; Doupnik, Stephanie K.; Zagel, Alicia; Bergmann, Kelly R.; Hoffmann, Jennifer A.; Neuman, Mark I.

doi:10.1016/j.acap.2019.05.132

Cited by 63 publications

(68 citation statements)

References 31 publications

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“…require an extended length of stay (LOS) and are more likely to need admission than children who present with a physical diagnosis. 6,8,10,11 Results from a recent Australian study had similar findings and also found that 22.5% of all paediatric MH presentations were for self-harm. 12 Prior to this, there were only two Australian studies of paediatric MH emergency presentations conducted almost two decades ago.…”

supporting

confidence: 52%

“…MH presentations can strain already limited ED resources, this cohort is more likely to have recurrent ED presentations, 15,16 require an extended length of stay (LOS) and are more likely to need admission than children who present with a physical diagnosis 6,8,10,11 . Results from a recent Australian study had similar findings and also found that 22.5% of all paediatric MH presentations were for self‐harm 12 .…”

Section: What Is Already Known On This Topicmentioning

confidence: 74%

“…Australian emergency departments (EDs) are seeing an alarming increase in MH presentations across all ages with the most rapid increases in the paediatric population 4,5 . This trend is consistent globally and has been well studied in North America 6–11 . However in Australia, paediatric‐specific studies are limited 12–14 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

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Mental health presentations to the paediatric emergency department: A retrospective study

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Carison

Hill

et al. 2021

J Paediatrics Child Health

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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.

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supporting

confidence: 52%

Section: What Is Already Known On This Topicmentioning

confidence: 74%

Section: What Is Already Known On This Topicmentioning

confidence: 99%

See 1 more Smart Citation

Mental health presentations to the paediatric emergency department: A retrospective study

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Carison

Hill

et al. 2021

J Paediatrics Child Health

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“…4 This tremendous burden of disease and concomitant shortage of behavioral and mental health professionals has resulted in a substantial increase in emergency department (ED) visits and hospitalizations for children and adolescents experiencing behavioral and mental health crises. [6][7][8] After initial evaluation and resolution of acute medical concerns, children and adolescents requiring inpatient mental health treatment often stay in the ED or are admitted to an inpatient medical unit while waiting for a psychiatric inpatient bed to become available. This practice is referred to as boarding, defined by The Joint Commission as, "the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made."…”

mentioning

confidence: 99%

Pediatric Mental Health Boarding

McEnany

Ojugbele²,

Doherty

et al. 2020

Pediatrics

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CONTEXT: The growing prevalence of pediatric mental and behavioral health disorders, coupled with scarce psychiatric resources, has resulted in a substantial increase in the number of youth waiting in emergency departments (EDs) and medical units for inpatient psychiatric care. OBJECTIVE: To characterize the prevalence of pediatric mental health boarding and identify associated patient and hospital factors. DATA SOURCES: Medline and PsycINFO. STUDY SELECTION: All studies describing frequencies, durations, processes, outcomes, and/or risk factors associated with pediatric mental health boarding in youth #21 years of age. DATA EXTRACTION: Publications meeting inclusion criteria were charted by 2 authors and critically appraised for quality. RESULTS: Eleven studies met inclusion criteria; 10 were retrospective cohort studies and 9 were conducted at single centers. All of the single-center studies were conducted at children's hospitals or pediatric EDs in urban or suburban settings. Study sample sizes ranged from 27 to 44 328. Among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and 26% to 49% boarded on inpatient medical units. Average boarding durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. Risk factors included younger age, suicidal or homicidal ideation, and presentation to a hospital during nonsummer months. Care processes and outcomes were infrequently described. When reported, provision of psychosocial services varied widely. LIMITATIONS: Boarding definitions were heterogeneous, study sample sizes were small, and rural regions and general hospitals were underrepresented. CONCLUSIONS: Pediatric mental health boarding is prevalent and understudied. Additional research representing diverse hospital types and geographic regions is needed to inform clinical interventions and health care policy.

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“…Over the past 2 decades, young people have increasingly sought acute mental health care in emergency departments (EDs). 1,2 In this issue of Pediatrics, Nash et al 3 examine ED length of stay for children with mental health conditions. They draw on 10 years of data from the National Hospital Ambulatory Medical Care Survey (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) to compare length of stay for visits with and without a mental health diagnosis.…”

mentioning

confidence: 99%