HEADS-ED as a Predictor of Hospitalization in Children Seeking Emergency Department Care With Mental Health Concerns

To evaluate the association between the Home, Education/Employment, Activities, Drugs, Suicidality, Emotions, Discharge (HEADS-ED) tool and hospitalization among children presenting with mental health concerns for emergency department (ED) care.

We conducted a cross-sectional analysis of data from a prospective quasi-experimental study evaluating an acute mental health care bundle in 2 pediatric EDs in Alberta, Canada. Participants were <18 years and presented with a mental health concern. A high-risk HEADS-ED score was defined by a total score ≥8 (range: 0-14) and/or suicide score of 2 (range: 0-2). Primary outcome was index ED visit hospitalization.

Seven hundred and fourteen eligible participants had complete data available for analysis. Median participant age was 14.0 (interquartile range [IQR]: 12.0, 15.0) years, 12.0% (86/714) of whom were hospitalized at the index ED visit. The HEADS-ED score was ≥8 for 16.9% (121/714) of participants and 28.6% (204/714) had a suicide risk score of 2; 35.7% (255/714) met one or both high-risk criteria. Exactly 79.1% (95%confidence interval [CI]: 69.0, 87.1) of hospitalizations were among children who had high-risk scores, whereas 70.2% (95%CI: 66.5, 73.8) of children who were discharged had low-risk scores. Similarly, including follow-up through 30 days after the index visit, 77.7% (95%CI: 67.9, 85.6) of hospitalizations were among children who had high-risk scores, while 70.7% (95%CI: 66.9, 74.2) of children who were not hospitalized had low-risk scores. Among children ≥14 years, HEADS-ED scores were inversely correlated with well-being scores.

In our study population, high-risk HEADS-ED scores are moderately associated with hospitalization. Adolescents with higher HEADS-ED scores reported lower well-being.