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Observational Study
. 2021 May;147(5):e2020030692.
doi: 10.1542/peds.2020-030692. Epub 2021 Apr 5.

Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015)

Katherine A Nash  1   2 , Bonnie T Zima  3 , Craig Rothenberg  4 , Jennifer Hoffmann  5 , Claudia Moreno  6 , Marjorie S Rosenthal  7   2 , Arjun K Venkatesh  4   8
Affiliations
Observational Study

Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015)

Katherine A Nash et al. Pediatrics. 2021 May.

Abstract

Background and objectives: Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits.

Methods: We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression.

Results: From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type.

Conclusions: The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Inclusion and exclusion criteria and visit sample used for each analysis.
FIGURE 2
FIGURE 2
Trends over time in rates of prolonged ED LOS for pediatric mental health and non–mental health visits (2005–2015). All results represent weighted estimates. We were unable to report population-level estimates for visits with prolonged LOS >24 hours because of sample size. A, Mental health ED visits. B, Non–mental health ED visits.
See this image and copyright information in PMC

Comment in

  • Equity in Emergency Mental Health Care.
    Krass P, Doupnik SK. Krass P, et al. Pediatrics. 2021 May;147(5):e2020049843. doi: 10.1542/peds.2020-049843. Epub 2021 Apr 5. Pediatrics. 2021. PMID: 33820848 Free PMC article. No abstract available.

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