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. 2011 Aug;20(3):208-13.

Clinical acuity of repeat pediatric mental health presentations to the emergency department

Andrea Y Yu  1 , Rhonda J Rosychuk, Amanda S Newton
Affiliations

Clinical acuity of repeat pediatric mental health presentations to the emergency department

Andrea Y Yu et al. J Can Acad Child Adolesc Psychiatry. 2011 Aug.

Abstract
in English, French

Objective: We examined whether clinical acuity changed in children and youth with repeated emergency department (ED) visits for mental illness. A secondary, exploratory objective was to examine characteristics associated with clinical acuity.

Method: We conducted a four-year historical cohort study reviewing data from 1,033 ED presentations by 474 patients (≤17 years) for mood disorders, neurotic/stress-related disorders, and psychosis-related illnesses. We used a multivariable generalized linear mixed model to examine the relationship between clinical acuity (defined by triage level at presentation) and length of time since initial ED visit. Interactions between diagnosis group and age group, sex, and visiting timing were also examined. Explanatory variables (patient demography, diagnosis, disposition, institutional classification and location) were entered into the model to explore their relationship to clinical acuity.

Results: Clinical acuity did not change between ED visits for children with mood disorders, neurotic/stress-related disorders, or psychosis-related illnesses. The median time to ED return was 7 days. Several characteristics were associated with a higher likelihood of increased clinical acuity at presentation: being male, presenting to the ED with a mood disorder, and attendance to an urban-based ED.

Conclusions: Repeat ED visits for several pediatric mental illnesses were not a result of destabilized conditions. Further investigation of the relationship between patient characteristics, available community services, and patterned mental health care use is needed to clarify ED utilization patterns.

Objectif:: Vérifier si les symptômes cliniques s’aggravent lorsque des enfants et des adolescents se présentent à plusieurs reprises à une Urgence psychiatrique; évaluer la gravité de ces symptômes.

Méthodologie:: Étude, pendant quatre ans, des données tirées de 1 033 visites effectuées par 474 patients (≤17 ans) qui se sont rendus à une Urgence pour troubles de l’humeur, névrose, stress ou maladie à comorbidité psychotique. Les auteurs ont étudié la relation entre la gravité des symptômes cliniques (définie par l’équipe chargée du triage à l’arrivée à l’Urgence) et le temps écoulé depuis la dernière visite à l’Urgence au moyen d’un modèle linéaire généralisé mixte multivariable. Ils ont analysé les interactions entre le diagnostic, l’âge, le sexe des patients et l’heure de la visite. Ils ont introduit certaines variables explicatives (données démographiques, âge du patient, disposition, type et emplacement de l’établissement de santé) dans le modèle afin d’étudier la relation entre ces facteurs et la gravité des symptômes cliniques.

Résultats:: Les symptômes cliniques ne s’aggravent pas lorsque les enfants se rendent à l’Urgence pour troubles de l’humeur, névrose, stress ou psychose. L’intervalle médian entre les visites était de sept jours. Les symptômes risquent de s’aggraver lorsque les patients sont de sexe masculin, qu’ils présentent un trouble de l’humeur et que l’établissement de santé se trouve en ville.

Conclusions:: Les visites répétées à l’Urgence ne sont pas dues à une détérioration de l’état des patients. Il convient d’approfondir l’étude de la relation entre les caractéristiques des patients, les services disponibles dans la communauté et le type de soins offerts en santé mentale afin de clarifier les schémas d’utilisation des urgences.

Keywords: emergency service; illness severity; pediatrics; psychiatry; repeat visits.

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