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Mental Health Utilization in a Pediatric Emergency Department
David C Sheridan1, David M Spiro, Rongwei Fu
1From the Departments of *Emergency Medicine, †Child and Adolescent Psychiatry, and ‡Care Management/Social Work, Oregon Health & Science University, Portland, OR.
Insights
Pediatric emergency department (PED) visits for mental health care increased significantly from 2009 to 2013. This trend indicates a growing need for resources to manage these pediatric mental health cases.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Healthcare Resource Utilization
Background:
- Mental health complaints are a frequent reason for pediatric emergency department (PED) visits.
- Previous data on trends in PED utilization for pediatric mental health care are limited.
Purpose of the Study:
- To describe trends in PED utilization for mental health care over time at a single pediatric tertiary care hospital.
- To test the hypothesis that resources used by this patient population are high and that mental health-related visits have increased.
Main Methods:
- Retrospective study of pediatric mental health presentations to the PED from January 2009 to July 2013.
- Included patients aged 1-19 years with specific ICD-9 codes related to mental disorders.
- Analyzed trends in presentation, charges, and length of stay (LOS) using mixed-effects regression models.
Main Results:
- 732 visits from 646 unique patients were identified; average age was 13.8 years, 53% male.
- 25% of patients expressed suicidal ideation; 33% experienced restraint use.
- Statistically significant increases in annual visits, LOS, and charges were observed (P < 0.05).
Conclusions:
- Pediatric mental health complaints in the PED have significantly increased in number and resource intensity (LOS) over time.
- Further research is needed to validate these findings nationally and inform resource allocation.
- The study highlights a growing demand for mental health services within pediatric emergency settings.
Objective:
Mental health complaints are frequent in the pediatric emergency department (PED). The objective of this study was to describe trends over time in PED utilization for mental health care at in a single pediatric tertiary care hospital. It is our hypothesis that the resources used by this patient population are high and that mental health-related visits have increased over the most recent decade.
Methods:
This was a retrospective study of all pediatric mental health presentations to the PED from January 2009 to July 2013 at a single pediatric hospital. All patients aged 1 to 19 years with an International Classification of Diseases, Ninth Revision code of 291, 292, 295 to 309, and 311 to 314 were included. Data collected included demographic data, medications received, restraint use, suicidality, length of stay (LOS), charges incurred, final disposition, and daily PED operation variables. Trends over time in presentation, charges, and LOS were analyzed using multiple mixed effects regression models after adjusting for potential patient and PED level confounding variables and clustering of multiple visits within patients.
Results:
A total of 732 PED visits from 2009 to 2013 were identified representing 646 unique patients. The average age was 13.8 years, and 53% were male. Approximately 25% of the patients expressed suicidal ideation, and 44% of those had attempted suicide before arrival. Behavioral or chemical restraints were used in 33% of patients during their PED visit. There were statistically significant increases in annual visits, LOS, and charges over this period (P < 0.05). Increased charges were significantly associated with longer LOS (P = 0.0062). Charges (P = 0.46) and LOS (P = 0.62) were not significantly different between suicidal and nonsuicidal patients. Approximately 21% of patients were admitted or transferred to another facility.
Conclusions:
In this single-center study, we found evidence that the resources required to care for pediatric patients with mental health complaints have increased significantly over time both by increased number of annual visits and an increasing LOS. Further research is necessary to determine if our data are consistent with national trends to further our understanding of the problem and improve resource allocation.
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