Emergency department mental health presentations in young children: a retrospective chart review

To characterise key features of young people presenting to the emergency department (ED) with a mental health complaint when comparing children (aged 7 to 12 years) and teenagers (13 years and greater).

Retrospective review of all ED mental health presentations in children aged 7-17 years presenting over a 12-month period in 2018 to a tertiary children's hospital in Victoria, Australia. Univariate analyses were carried out to examine the relationship between children and teenagers and a number of key presentation variables. Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated for ED management outcomes.

There were 1691 ED mental health presentations in 2018. Of these presentations, 407 (24%) were children aged 12 years or less. The remaining 76% (1284) were teenagers. The younger aged cohort were more likely to be male (OR 2.43, CI 1.92-3.08) and have a past history of autism spectrum disorder (OR 1.92, CI 1.45-1.84). They were more likely to have a presenting complaint of acute behavioural disturbance (OR 2.03, CI 1.59-2.60), be physically restrained (OR 2.01, CI 1.18-3.37) and have sedative medication provided (OR 2.87, CI 1.63-5.04). The older aged cohort were more likely to have a past history of depression (OR 0.19, CI 0.12-0.29) and a presenting complaint of intentional self-poisoning (OR 0.33, CI 0.15-0.65).

Children aged 12 years or less represent one-quarter of all young people presenting to the ED with a mental health concern. They experience high rates of acute behavioural disturbance and are more likely to require restrictive interventions during their presentation.