Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Objectives While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics. Methods This was a retrospective, cross-sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors. Results From 2001 to 2010, an average of 28.3 million pediatric visits to EDs occurred annually. Among those, an approximately 560,000 (2% of ED visits) were psychiatric visits each year. Pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010 (p = 0.01). Teenagers (adjusted odds ratio [AOR] = 3.92, 95% confidence interval [CI] = 3.37 to 4.57) and publicly insured patient visits (AOR = 1.47, 95% CI = 1.25 to 1.74) had increased odds of psychiatric ED visits. Conclusions Pediatric ED psychiatric visits are increasing. Teenagers and children with public insurance appear to be at increased risk. Further investigation is needed to determine what the causative factors are. Resumen Objetivos Estudios recientes han demostrado un incremento global en las visitas psiquiatricas al servicio de urgencias (SU), pero ninguno se ha centrado en una poblacion pediatrica nacional representativa. El comprender las tendencias en las visitas pediatricas psiquiatricas al SU es importante por la disponibilidad ambulatoria limitada de especialistas pediatricos, asi como por los tiempos de espera largos para las citas psiquiatricas. El objetivo del estudio fue evaluar la tendencia en las visitas de ninos al SU por motivos psiquiatricos entre 2001 y 2010, y comparar las caracteristicas sociodemograficas. Metodologia Analisis transversal retrospectivo de las visitas psiquiatricas al SU de ninos menores de 18 anos mediante la National Hospital Ambulatory Medical Care Survey. Las visitas se identificaron mediante los codigos de la Clasificacion Internacional de Enfermedades, novena version (CIE-9). Las medidas de resultado incluyeron frecuencia de visitas de ninos con una codificacion diagnostica psiquiatrica, la razon de ventajas (OR) y la razon de ventajas ajustada (ORa) de visitas psiquiatricas controlada por factores geograficos, demograficos y temporales. Resultados Desde 2001 a 2010, hubo una media anual de 28,3 millones de visitas pediatricas a los SU. Entre ellas, aproximadamente 560.000 (1,98% de las visitas al SU) fueron visitas psiquiatricas. Las visitas psiquiatricas pediatricas al SU se incrementaron de una estimacion de 491.000 en 2001 a 619.000 en 2010 (p = 0,01). Las visitas de pacientes con seguro publico (ORa 1,47, IC 95% = 1,25 a 1,74) y los adolescentes (ORa 3,92, IC 95%= 3,37 a 4,57) han aumentado la razon de ventajas de las visitas psiquiatricas al SU. Conclusiones Las visitas pediatricas por motivos psiquiatricos al SU estan incrementandose. Los adolescentes y los ninos con seguro publico tienen un mayor riesgo. Son necesarias futuras investigaciones para determinar cuales son los factores causales.