The burden of mental and behavioral health visits to the pediatric ED: A 3-year tertiary care center experience

IF 6.8 3区医学 Q1 PEDIATRICS

Child and Adolescent Mental Health Pub Date : 2023-02-16 DOI:10.1111/camh.12638

Matthias M. Manuel, Kenneth Yen, Sing-Yi Feng, Faisalmohemed Patel

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引用次数: 1

Abstract

Background

The shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety-nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH-related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate.

Methods

We reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi-square (χ²), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission.

Results

Of 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), overdose/poisoning, and substance use (18.8%), and agitation/aggression (10.7%). Median EDLOS was 5.3 hr, average admission rate was 26.3%, with 20.7% boarding in the ED for >10 hr. Independent predictors of admission include depression (pOR: 1.5, CI: 1.3–1.7), bipolar disorder (pOR: 3.5, CI: 2.4–5.1), overdose/substance use disorder (pOR: 4.7, CI: 4.0–5.6), psychosis (pOR: 3.3, CI: 1.5–7.3), agitation/aggression (pOR: 1.8, CI: 1.5–2.1), and ADHD (pOR: 2.5, CI: 2.0–3.0). Principal independent driver of prolonged EDLOS was patient admission/transfer status (pOR: 5.3, CI: 4.6–6.1).

Conclusions

Given the study results, MBH-related PED visits, ED length-of-stay, and admission rates continue to rise even in recent years. PEDs lack the resources and capability to provide high-quality care for the increasing population of children with MBH needs. Novel collaborative approaches and strategies are urgently needed to find lasting solutions.

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儿科ED的心理和行为健康就诊负担：三年三级护理中心经验。

背景：美国各地心理健康服务的短缺已将儿科急诊科（PED）变成了满足日益增多的心理和行为健康需求儿童的安全网。本研究提供了MBH相关PED访视、访视趋势、ED住院时间（EDLOS）和入院率的描述性特征。方法：我们回顾了≤18岁儿童的电子健康记录 2017年1月至2019年12月，他访问了一家大型三级医院的PED。我们进行了描述性统计、卡方（χ2）和逻辑回归分析，以评估就诊趋势、EDLOS、入院率以及EDLOS延长和住院的预测因素。结果：10167名患者中，58.4%为女性，中位年龄13.8岁 86.1%为青少年。访问量平均每年增长19.7%，比3次增长43.3% 年。常见的ED诊断包括自杀（56.2%）、抑郁（33.5%）、过量/中毒和药物使用（18.8%）以及激动/攻击（10.7%）。中位EDLOS为5.3小时，平均入院率为26.3%，20.7%的患者在ED住院>10小时。入院的独立预测因素包括抑郁症（pOR:1.5，CI:1.3-1.7）、双相情感障碍（pOR:3.5，CI:2.4-5.1，和ADHD（pOR:2.5，CI:2.0-3.0）。EDLOS延长的主要独立驱动因素是患者入院/转移状态（pOR:5.3，CI:4.6-6.1）。PED缺乏资源和能力，无法为越来越多有MBH需求的儿童提供高质量的护理。迫切需要新的合作方法和战略来找到持久的解决办法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Child and Adolescent Mental Health PEDIATRICS-PSYCHIATRY

CiteScore

8.30

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Child and Adolescent Mental Health (CAMH) publishes high quality, peer-reviewed child and adolescent mental health services research of relevance to academics, clinicians and commissioners internationally. The journal''s principal aim is to foster evidence-based clinical practice and clinically orientated research among clinicians and health services researchers working with children and adolescents, parents and their families in relation to or with a particular interest in mental health. CAMH publishes reviews, original articles, and pilot reports of innovative approaches, interventions, clinical methods and service developments. The journal has regular sections on Measurement Issues, Innovations in Practice, Global Child Mental Health and Humanities. All published papers should be of direct relevance to mental health practitioners and clearly draw out clinical implications for the field.