[Acute admissions in pediatric psychiatry]

This is a case study of 49 acute admissions to the Child Psychiatry Department at the Copenhagen County Hospital in Glostrup over the four year period 1.1.1990-31.12.1993. The aim is to appraise the concept of acute child psychiatric admission, examine the relation between definition and practice and evaluate the acute service and its viability. A retrospective analysis of the case notes shows that the 42 children involved constitute a selected group of mainly 11-14 years old girls, the most frequent diagnosis at referral- and at discharge-being anorexia nervosa. Most cases are referred from paediatric departments. Eighty percent of the acutely admitted children have had previous contact with one or more institutions. Time interval breakdown shows that more than a quarter of the cases were admitted some weeks after referral. The acute group had on average fewer hospital days than all other cases and only 12% were discharged without needing of further treatment. A further analysis revealed an inconsistency in terms of definition and practice. Only 39% of the patients were admitted within a 24-hour period after the acute referral, while 74% were admitted within the first week. The explanation is offered, that the definitions of and the indications for acute child psychiatric hospitalisation were loosely formulated and different from the more stringent medical terms and that some cases must be seen as being more of a subacute nature or representing clinical or social relapses. The question is raised whether the concept of acute admission in child psychiatric terms is viable.