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Inpatient pediatric consultation-liaison: a case-controlled study
Bryan D Carter1, William G Kronenberger, Janet Baker
1University of Louisville School of Medicine, Kentucky 40202, USA. bdcart01@louisville.edu
Insights
Pediatric inpatients referred for consultation showed more behavioral difficulties than their peers. These consultations were highly rated by physicians and parents for improving patient coping and adjustment.
Area of Science:
- Pediatric Psychology
- Child Psychiatry
- Behavioral Health
Background:
- Pediatric inpatients often present with behavioral and adjustment challenges.
- The role of specialized consultations in managing these difficulties requires further investigation.
Purpose of the Study:
- To compare behavioral and adjustment functioning between referred and non-referred pediatric inpatients.
- To evaluate the effectiveness of consultations in addressing these issues.
Main Methods:
- A prospective case-controlled study matched 104 referred inpatients with 104 non-referred inpatients.
- Behavioral rating scales were completed by parents, patients (self-report), and nurses.
- Goal attainment and satisfaction were assessed by referring physicians, parents, and consultants.
Main Results:
- Referred pediatric inpatients demonstrated significantly more internalizing and externalizing disturbances compared to non-referred peers.
- Common interventions included coping strategies, cognitive behavioral therapies, and case management.
- High ratings for goal attainment and satisfaction were reported by physicians, parents, and consultants.
Conclusions:
- Behavioral and adjustment problems leading to consultation referrals often predate hospitalization.
- In-hospital consultations are perceived as beneficial for managing pediatric patients' health concerns, coping, and adjustment.
- Consultations positively impact overall patient management and well-being.
Objective:
To conduct a prospective case-controlled study of pediatric inpatients referred for consultation in a tertiary care children's medical center.
Method:
Referrals (n = 104) were matched with nonreferrals (n = 104) for age (4 to 18 years), gender, and illness type/severity and completed parent- and self-report (dependent on age) behavioral rating scales to assess for adjustment/functioning. Nurses completed in-hospital ratings of behavioral/adjustment difficulties. Goal attainment and satisfaction ratings were obtained from the referring physicians, parents/guardians, and the consultant.
Results:
Referrals exhibited more behavior/adjustment/coping difficulties than nonreferrals by parent, nurse, and self report. Frequently employed interventions included coping-strategies intervention, cognitive and behavioral therapies, and case management. Referring physician and consultant ratings of goal attainment were high, as were physician ratings of satisfaction and parent/guardian ratings of overall helpfulness.
Conclusions:
Pediatric inpatients referred by their physicians had significantly more internalizing and externalizing disturbances than their nonreferred hospitalized peers. Many of the behavioral and adjustment problems that lead to in-hospital consultation referral were evident in global behavior difficulties prior to hospitalization. Referring pediatricians, parents/guardians, and consultants rate the outcome as benefiting the patients via assisting in the overall management of their health concerns, coping, and adjustment.