The burden of mental and behavioral health visits to the pediatric ED: A 3-year tertiary care center experience.
The burden of mental and behavioral health visits to the pediatric ED: A 3-year tertiary care center experience.
复制标题
儿科急诊科就诊的心理和行为健康负担：三年三级护理中心的经验。
DOI：
10.1111/camh.12638
复制
发表时间：
2023
影响因子：
6.1
通讯作者：
Faisalmohemed Patel
中科院分区：
文献类型：
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作者：
Matthias M Manuel;K. Yen;S. Feng;Faisalmohemed Patel
背景
美国各地心理健康服务的短缺使得儿科急诊室 (PED) 成为了越来越多有心理和行为健康 (MBH) 需求的儿童的安全网。本研究提供了与 MBH 相关的 PED 就诊、就诊趋势、ED 住院时间 (EDLOS) 和入院率的描述性特征。
方法
我们回顾了 2017 年 1 月至 2019 年 12 月到一家大型三级医院 PED 就诊的有 MBH 需求的 ≤18 岁儿童的电子健康记录。我们进行了描述性统计、卡方 (χ2 ) 和逻辑回归分析，以评估就诊趋势、EDLOS、入院率以及延长 EDLOS 和住院的预测因素。
结果
在 10,167 名患者中，58.4% 为女性，中位年龄为 13.8 岁，86.1% 为青少年。平均每年访问量增长 19.7%，3 年来增长 43.3%。常见的 ED 诊断包括自杀（56.2%）、抑郁（33.5%）、服药过量/中毒和药物滥用（18.8%）以及激越/攻击性（10.7%）。 EDLOS 中位数为 5.3 小时，平均入院率为 26.3%，其中 20.7% 在 ED 寄宿时间超过 10 小时。入院的独立预测因素包括抑郁症（pOR：1.5，CI：1.3-1.7）、双相情感障碍（pOR：3.5，CI：2.4-5.1）、药物过量/药物滥用障碍（pOR：4.7，CI：4.0-5.6）、精神病（pOR：3.3，CI：1.5-7.3）、激越/攻击性（pOR： 1.8，CI：1.5-2.1）和 ADHD（pOR：2.5，CI：2.0-3.0）。延长 EDLOS 的主要独立驱动因素是患者入院/转院状态（pOR：5.3，CI：4.6-6.1）。
结论
根据研究结果，近年来，与 MBH 相关的 PED 就诊次数、ED 住院时间和入院率持续上升。 PED 缺乏资源和能力，无法为不断增加的有 MBH 需求的儿童提供高质量的护理。迫切需要新的协作方法和策略来找到持久的解决方案。
BACKGROUND
The shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety-nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH-related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate.
METHODS
We reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi-square (χ2 ), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission.
RESULTS
Of 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), overdose/poisoning, and substance use (18.8%), and agitation/aggression (10.7%). Median EDLOS was 5.3 hr, average admission rate was 26.3%, with 20.7% boarding in the ED for >10 hr. Independent predictors of admission include depression (pOR: 1.5, CI: 1.3-1.7), bipolar disorder (pOR: 3.5, CI: 2.4-5.1), overdose/substance use disorder (pOR: 4.7, CI: 4.0-5.6), psychosis (pOR: 3.3, CI: 1.5-7.3), agitation/aggression (pOR: 1.8, CI: 1.5-2.1), and ADHD (pOR: 2.5, CI: 2.0-3.0). Principal independent driver of prolonged EDLOS was patient admission/transfer status (pOR: 5.3, CI: 4.6-6.1).
CONCLUSIONS
Given the study results, MBH-related PED visits, ED length-of-stay, and admission rates continue to rise even in recent years. PEDs lack the resources and capability to provide high-quality care for the increasing population of children with MBH needs. Novel collaborative approaches and strategies are urgently needed to find lasting solutions.