Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit.

TitleTrends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit.
Publication TypeJournal Article
Year of Publication2019
AuthorsCutler GJ, Rodean J, Zima BT, Doupnik SK, Zagel AL, Bergmann KR, Hoffmann JA, Neuman MI
JournalAcad Pediatr
Date Published2019 Jun 05
ISSN1876-2867
Abstract

OBJECTIVE: To examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU).

STUDY DESIGN: Cross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital.

RESULTS: From 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH vs. non-MH diagnosis (50.7% vs. 12.7% cumulative increase, P<.001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P<.001). 44% of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs. 22.5%, P<.001) and less transfers (9.3% vs. 16.2%, P<.001).

CONCLUSION: The increase in ED MH visits from 2012 to 2016 was four times greater than non-MH visits at US children's hospitals, and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.

DOI10.1016/j.acap.2019.05.132
Alternate JournalAcad Pediatr
PubMed ID31175994