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A checklist of hospitalization criteria for use with children
A J Costello1, M K Dulcan, R Kalas
1University of Massachusetts Medical School, Worcester 01655.
Insights
A new checklist accurately predicts psychiatric hospitalization for children. This tool can guide clinical decisions and improve utilization review for child mental health services.
Area of Science:
- Child and Adolescent Psychiatry
- Clinical Psychology
- Healthcare Decision Support
Background:
- Over 130,000 children are hospitalized annually in the U.S. for psychiatric reasons.
- Hospitalization decisions involve complex factors and can be challenging, particularly for less experienced clinicians.
Purpose of the Study:
- To evaluate the predictive accuracy of a 12-item checklist for psychiatric hospitalization in children.
- To assess the utility of a shorter, 6-item checklist for predicting treatment disposition.
Main Methods:
- A cohort of 389 children aged 2-12 underwent evaluation for inpatient or outpatient psychiatric treatment.
- A 12-item checklist was adapted and tested for its ability to predict subsequent hospitalization.
- A 6-item checklist was also analyzed for predictive accuracy.
Main Results:
- The 12-item checklist correctly predicted hospitalization in 95% of cases.
- The shorter 6-item checklist also demonstrated 95% accuracy in predicting treatment outcomes.
- 22% of the evaluated children (87 out of 389) were subsequently hospitalized.
Conclusions:
- Checklists can serve as valuable decision-making aids for child psychiatric hospitalization.
- These tools can support less experienced mental health professionals and aid in utilization review.
- While not replacing clinical judgment, checklists enhance consistency and objectivity in treatment decisions.
Abstract:
Each year in the U.S. more than 130,000 children are hospitalized for psychiatric reasons. The decision to hospitalize a child is based on a complex set of factors. In this study, a 12-item checklist of criteria for hospitalization adapted by the authors was tested for its ability to predict hospitalization in a cohort of 389 children between the ages of two and 12 who were evaluated for either inpatient or outpatient treatment. Eighty-seven (22 percent) of the children were subsequently hospitalized. In 95 percent of the cases, the checklist was able to correctly predict whether the patient was hospitalized. A shorter checklist of six items was also able to predict the subsequent form of treatment in 95 percent of the cases. Although such checklists cannot take the place of informed clinical decisions, they can serve as a guide to decision making, especially for inexperienced mental health workers, and as a tool for utilization review when treatment decisions are questioned.