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Abstract
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OBJECTIVES: Describe the demographic and clinical characteristics of children presenting to the emergency department (ED) for agitation and aggression from school vs other sites.
METHODS: We performed a retrospective cross-sectional study of children 5-18 years old who were evaluated in an urban tertiary care pediatric ED with a chief complaint of agitation or aggression. We examined demographics, disposition, and payments for children presenting from school vs other sites. We conducted multivariable logistic regression to identify predictors of referral site (school vs all other sites, school vs home) and discharge status (home vs higher level of psychiatric care).
RESULTS: Of the 513 included children, 147 (29%) presented from school. Children were more likely to present from school vs other sites if they were Black (aOR 2.26, 95% CI 1.32, 3.88), Latinx (aOR 2.91, 95% CI 1.42, 5.97), or had special educational needs (aOR 2.55, 95% CI 1.64, 3.97). These associations persisted in the analysis of school vs home referrals. Children presenting from school vs all other sites were more likely to be discharged home (aOR 1.60, 95% CI 1.05, 2.44), although this difference did not persist when comparing school vs only home referral. A total of $154,269 (median $367 per encounter) was paid for school referrals to the ED.
CONCLUSIONS: Children with agitation and aggression referred from school were more likely to be Black, Latinx, or have special educational needs. Future efforts should identify and address root causes of this disparity to decrease ED referrals, reduce healthcare spending, and address inequities.
Language: en |