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. 2019 Nov-Dec;19(8):948-955.
doi: 10.1016/j.acap.2019.05.132. Epub 2019 Jun 5.

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

Gretchen J Cutler  1 , Jonathan Rodean  2 , Bonnie T Zima  3 , Stephanie K Doupnik  4 , Alicia L Zagel  5 , Kelly R Bergmann  6 , Jennifer A Hoffmann  7 , Mark I Neuman  7
Affiliations

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

Gretchen J Cutler et al. Acad Pediatr. 2019 Nov-Dec.

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 versus 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). Forty-four percent 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 (9.2% vs 16.2%, P < .001).

Conclusion: The increase in ED MH visits from 2012 to 2016 was 4 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.

Keywords: depression; discharge disposition; emergency department; pediatric mental health; suicide or self-injury.

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Conflict of interest statement

Potential Conflict of Interest and Corporate Sponsors: None

Figures

Figure 1
Figure 1
Cumulative % Growth from 2012 to 2016 for Primary MH vs. Primary Non-MH ED visits
See this image and copyright information in PMC

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