Psychotropic medication use for paediatric mental health patients in an emergency department
Sinead M O'Donnell1,2, Anna Carison1, Ashley Hill2
1Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
A small percentage of pediatric emergency department (ED) visits for mental health (MH) issues involved psychotropic medication. Males, acutely ill patients, and those with longer ED stays were more likely to receive these medications.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Clinical Pharmacology
Background:
- Limited evidence exists regarding psychotropic medication use in pediatric mental health emergencies.
- Understanding current prescribing practices is crucial for improving patient care.
Purpose of the Study:
- To describe the use of psychotropic medications in children and adolescents presenting with mental health problems to the emergency department (ED).
Main Methods:
- Retrospective review of electronic medical records for pediatric ED patients with mental health discharge codes in 2018.
- Analysis of demographic factors, triage category, ED length of stay, and medication regimens.
- Calculation of odds ratios for medicated versus non-medicated patients.
Main Results:
- 16.5% of 1695 mental health presentations received psychotropic medication.
- Medicated children were more likely to be male, have acute triage, longer ED stays (>12h), and present after hours.
- Common diagnoses included acute behavioral disturbance and suicidal ideation; diazepam or olanzapine were primary single oral agents.
Conclusions:
- A minority of pediatric mental health ED visits involved psychotropic medication.
- Further multicenter research is needed to establish optimal acute psychotropic agents for pediatric ED use.
Objective:
There is paucity of evidence for psychotropic medication use in children and adolescents presenting with mental health (MH) problems to the ED. We set out to describe paediatric psychotropic medication use in the ED.
Methods:
We conducted a retrospective electronic medical record review of ED patients with MH discharge codes at a tertiary paediatric ED in 2018. We assessed the epidemiology and management of patients who received a psychotropic medication. We calculated the odds ratios (ORs with 95% confidence intervals [CIs]) of key demographic factors of medicated versus non-medicated MH patients.
Results:
During 2018 there were 1695 MH-related presentations to the ED. Of these, 280 presentations resulted in the patient receiving a psychotropic medication (16.5%). Medicated children with MH illness were more likely to be male (OR 1.50, 95% CI 1.16-1.96), have a more acute triage category (OR 3.37, 95% CI 2.28-4.98), have an ED length of stay greater than 12 h (OR 3.96, 95% CI 2.56-6.13) and present after hours (OR 1.51, 95% CI 1.16-1.96). Most had a diagnosis of acute behavioural disturbance or suicidal ideation. A variety of treatment regimens were used but children primarily received a single oral agent (diazepam or olanzapine). Parenteral medications were given in 8.6%. No adverse events were recorded.
Conclusion:
A minority of children with MH presentations to the ED were medicated. It will require multicentre research to determine the most effective and safe acute psychotropic agents for oral and parenteral use in children in the ED.
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