Citation

Gerson R, Havens J, Marr M, Storfer-Isser A, Lee M, Rojas Marcos C, Liu M, Horwitz SM. Psychiatr. Serv. 2017; 68(11): 1104-1111.

Affiliation

Dr. Gerson and Dr. Havens are with the Department of Child and Adolescent Psychiatry, Bellevue Hospital Center, New York. They are also with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, where Ms. Lee, Dr. Liu, and Dr. Horwitz are affiliated. Ms. Marr is with the Department of Behavioral Neuroscience, Oregon Health and Science University, Portland. Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Rojas Marcos is with the School of Public Health, George Washington University, Washington, D.C.

Copyright

(Copyright © 2017, American Psychiatric Association)

DOI

10.1176/appi.ps.201600436

PMID

28617206

Abstract

OBJECTIVE: Most youths experiencing a psychiatric crisis present to emergency departments (EDs) that lack the specialized staff to evaluate them, so youths are often discharged without appropriate mental health assessment or treatment. To better understand the needs of this population, this study described clinical details and disposition associated with visits for psychiatric emergencies to a specialized ED staffed 24/7 by child psychiatrists.

METHODS: Through retrospective chart review, 1,180 visits to the ED during its first year of operation were reviewed for clinical characteristics, prior service utilization, and demographic characteristics. Bivariate analyses (chi-square test and Wilcoxon rank sum test) compared differences in disposition (evaluate and release, brief stabilization, and inpatient psychiatric admission) associated with characteristics of the children's first visit (N=885). Measures with bivariate association of p<.10 were further assessed by using multinomial logistic regression analyses.

RESULTS: For most visits (59%), children were evaluated and released, 13% were briefly stabilized, and 28% were admitted for psychiatric treatment. Youths with mood or psychotic disorders were more likely to be admitted, as were those with current suicidality or aggression. Many youths who presented with aggression were also identified as having suicidality or self-harm.

CONCLUSIONS: Clinical factors, especially suicidality, predicted psychiatric admission. Admission rates for youths with suicidality were significantly higher in this study than previously reported, suggesting the availability of child psychiatrists in this ED allowed greater ascertainment of suicide risk (and thus hospitalization to mitigate that risk) than occurs in EDs without such staffing.

Language: en

Keywords

Admissions & readmissions, Brief hospitalization, Child psychiatry/general, Emergency psychiatry, Suicide-adolescent