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Trends in resource utilization for new-onset psychosis hospitalizations at children's hospitals
Ankita Gupta1,2, Matt Hall3, Benjamin Masserano1,2
1Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas Southwestern, Dallas, Texas, USA.
Insights
Hospitalizations for pediatric new-onset psychosis remain stable, but medical evaluations vary significantly across children's hospitals. Increased resource use highlights the need for evidence-based practice guidelines.
Area of Science:
- Pediatric Psychiatry
- Healthcare Management
- Clinical Epidemiology
Background:
- Children with new-onset psychosis frequently require hospitalization for comprehensive medical evaluation.
- Understanding management variations is crucial for optimizing care in pediatric psychiatric emergencies.
Purpose of the Study:
- To assess variations in the medical management of pediatric new-onset psychosis.
- To characterize trends in resource utilization during these hospitalizations.
Main Methods:
- Analysis of 7126 index hospitalizations for psychosis in children (ages 7-18) from 2011-2022 using the Pediatric Health Information System (PHIS) database.
- Exclusion of children with complex chronic conditions.
- Statistical analysis using covariance tests and generalized estimating equations to assess variability and trends in resource utilization (medication, imaging, laboratory, etc.), adjusting for covariates.
Main Results:
- Significant variations in resource utilization were observed across 37 children's hospitals (p < .001).
- Antipsychotic medications (76%), serum chemistry (77%), and toxicology labs (72%) were most common; brain MRI was used in 22%.
- Notable increases in utilization included laboratory tests, brain imaging, anesthetic use, and intravenous immunoglobulin.
Conclusions:
- Hospitalization rates for pediatric new-onset psychosis are stable, but significant variability exists in medical evaluations.
- Increasing and varied resource utilization underscores the need for evidence-based practice guidelines and consensus in managing these cases.
Background:
Children with new-onset psychosis often require hospitalization for medical evaluation.
Objectives:
The goal of this study was to assess variations in the management of children with new-onset psychosis and characterize trends in resource utilization.
Methods:
The study included index hospitalizations for children ages 7-18 admitted to children's hospitals with a primary diagnosis of psychosis from 2011 to 2022 using the Pediatric Health Information System (PHIS) database. Children with a complex chronic condition were excluded. Resource utilization categories included medication, imaging, laboratory, and other clinical resources. Variability in resource utilization was assessed using covariance tests for random intercepts with generalized linear modes after adjusting for age, sex, payor, and severity. Trends in resource utilization were examined using generalized estimating equations adjusting for the same factors and accounting for hospital clustering.
Results:
Our data set included 7126 new-onset psychosis hospitalizations from 37 children's hospitals. Teenage males and non-Hispanic Whites were most likely to be hospitalized. There was a significant variation in resource utilization across hospitals in all categories (p < .001). The most frequently utilized resources were antipsychotic medications (76%), serum chemistry (77%), toxicology labs (72%), and brain magnetic resonance imaging (22%). The most notable increases in utilization were in the performance of laboratory tests, brain imaging, anesthetic use, and intravenous immunoglobulin use.
Conclusion:
Study findings suggest that there has been a stable rate of hospitalization for children with new-onset psychosis, yet a significant variation in the medical evaluation exists. Significant increases and variations in resource utilization across all categories suggest an emerging need for robust evidence and consensus-based practice guidelines.
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