Citation

King CD, Joyce VW, Nash CC, Buonopane RJ, Sossong AD, Ressler KJ. Psychiatr. Serv. 2019; 70(7): 613-616.

Affiliation

Department of Mental Health Research (King, Joyce, Nash) and McLean Franciscan Department of Child and Adolescent Mental Health Programs (Buonopane, Sossong), Franciscan Children's, Brighton, Massachusetts; Division of Depression and Anxiety Disorders (King, Ressler) and Division of Child and Adolescent Psychiatry (Buonopane, Sossong), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Ressler).

Copyright

(Copyright © 2019, American Psychiatric Association)

DOI

10.1176/appi.ps.201800441

PMID

31010411

Abstract

OBJECTIVE: Emergency department (ED) use has increased disproportionately for pediatric psychiatric care. This study aimed to identify predictors of ED use within 30 days of discharge from a pediatric psychiatric hospitalization.

METHODS: ED use was assessed in the 30 days after discharge. Univariate logistic regression modeling identified predictors of ED use, which were used in subsequent multivariate modeling.

RESULTS: Greater number of trauma types (odds ratio [OR]=1.92, 95% confidence interval [CI]=1.50-2.45, z=2.67, p=0.008), generalized anxiety disorder (OR=3.20, 95% CI=1.78-5.76, z=1.98, p=.048), and longer length of stay (OR=1.05, 95% CI=1.03-1.07, z=2.74, p=0.006) were associated with increased ED use within 30 days of discharge.

CONCLUSIONS: ED use may be an important marker of negative outcomes within 30 days of discharge from pediatric psychiatric hospitalization. Patients with high trauma exposure, anxiety, and acuity marked by increased length of stay may require additional services to prevent unplanned ED use for psychiatric crises.

Language: en

Keywords

Adolescent; emergency department; generalized anxiety disorder; pediatric; psychiatric hospitalization; trauma