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The utility of universal screening for somatization in a pediatric emergency department: A prospective evaluation
Punit Virk1,2, Jacob Ellis3, Amrit Dhariwal2,3
1School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Insights
Pediatric emergency departments can detect somatization through universal screening. However, few families attended the psychoeducational follow-up, indicating a need for improved intervention strategies.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Psychosomatic Medicine
Background:
- Somatization is a common presentation in pediatric emergency departments (EDs).
- Early identification and intervention are crucial for managing somatization in youth.
- A standardized screening approach in the ED can facilitate early detection.
Purpose of the Study:
- To assess the clinical utility and feasibility of universal somatization screening in a pediatric ED.
- To evaluate a standardized approach involving symptom identification, mind-body connection education, psychiatric assessment, and psychoeducational follow-up.
- To determine the rate of positive somatization screens and subsequent engagement in follow-up care.
Main Methods:
- A cross-sectional study was conducted in a pediatric ED.
- Universal screening for somatization symptoms was performed by ED clinicians.
- Patients screening positive were assessed by a study psychiatrist, and families were invited to psychoeducational follow-up.
Main Results:
- Out of 344 screened patients, 7.8% (27) screened positive for somatization.
- 92.6% of families consented to meet with a psychiatrist, and 77.8% consented to a psychiatric assessment.
- All 21 assessed youth showed a likelihood of somatization; however, only 10% of invited families attended follow-up.
Conclusions:
- Universal somatization screening is feasible in the pediatric ED setting.
- A significant gap exists between invitation and attendance for psychoeducational follow-up.
- Further research is needed to develop effective ED-initiated interventions for pediatric somatization.
Objective:
To evaluate clinical utility and feasibility of universal somatization screening in the pediatric emergency department (ED) using a standardized approach of (1) identifying potential somatizing symptoms within the ED, (2) introducing these patients and their caregivers to the concept of the 'mind-body connection', (3) corroborating the likelihood of a somatization diagnosis via brief psychiatric assessment, and (4) inviting families to a psychoeducational follow-up session.
Methods:
We conducted a cross-sectional study to carry out this approach with families visiting a pediatric ED. Our primary outcome of screening utility was measured as the proportion of youth who screened positive for somatization by the ED clinician. Our secondary outcome of screening feasibility was measured as the proportion of patients with positives who (1) agreed to meet with the study psychiatrist, (2) consented to an ED psychiatric assessment, (3) were assessed by the study psychiatrist as likely experiencing somatization, and (4) were invited for follow-up and attended.
Results:
Of the 344 screened patients, 27 (7.8%) screened positive for somatization. Of these, 25 (92.6%) families verbally consented to meet the study psychiatrist to learn about the mind-body connection, and 21 (77.8%) consented to further psychiatric assessment. Upon assessment, the somatization likelihood was supported for all 21 youth. Twenty families were invited to follow-up and ultimately two (10%) attended.
Conclusions:
Somatization can be detected through ED-based universal screening. Few families attended psychoeducational follow-up. Further research is needed to determine appropriate ED-initiated pediatric somatization intervention.
