Newton Amanda S, Ali Samina, Hamm Michele P, Haines Christina, Rosychuk Rhonda J, Warron Lesley, Johnson David W, Klassen Terry P
From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 2J3.
Pediatr Emerg Care. 2011 Apr;27(4):275-83. doi: 10.1097/PEC.0b013e31821314ca.
: We examine psychiatric and pediatric clinical management of pediatric mental health in the emergency department (ED).
: We conducted a retrospective review of health care delivery with a random sample of all pediatric mental health presentations (≤18 years) to 2 urban tertiary care EDs between 2004 and 2006 (N = 580).
: The EDs differed significantly in services offered. General emergency medicine-trained physicians provided care at 1 site (54.6%) with a number of visits also managed by a psychiatric crisis team (45.4%). Care at the other ED was delivered by pediatric emergency medicine-trained physicians (99.4%) with no regular on-site psychiatric services. The most common assessment provided across sites and all presentations was for suicidality (66.2%). After controlling for potential confounders, receipt of clinical assessment for homicidality, mood, or reality testing differed between EDs (P = 0.044, P = 0.006, and P = 0.002) with more assessments documented at the psychiatric-resourced ED. Brief counseling was lacking for visits (absence of documentation: 56.1% pediatric-resourced, 23.1% psychiatric-resourced ED); there was no evidence of site differences in provision. More psychiatric consultation was provided at the psychiatric-resourced ED (34.1% vs 27.4%, P = 0.030). Discharge recommendations were lacking in both EDs but were more incomplete for pediatric-resourced ED visits (P = 0.035).
: Consistent and comprehensive clinical management of pediatric mental health presentations was lacking in EDs that had pediatric and psychiatric resources. Prospective evaluations are needed to determine the effect of current clinical ED practices on patient and family outcomes, including symptom reduction and stress, as well as subsequent system use.
我们研究了急诊科（ED）中儿童心理健康的精神病学和儿科临床管理。
我们对2004年至2006年间到两家城市三级医疗急诊科就诊的所有儿童心理健康病例（≤18岁）的随机样本进行了医疗服务的回顾性研究（N = 580）。
两家急诊科提供的服务有显著差异。在一个地点，由普通急诊医学培训的医生提供护理（54.6%），一些就诊病例也由精神科危机处理团队管理（45.4%）。另一家急诊科的护理由儿科急诊医学培训的医生提供（99.4%），没有常规的现场精神科服务。各地点和所有就诊病例中最常见的评估是自杀倾向（66.2%）。在控制潜在混杂因素后，两家急诊科在杀人倾向、情绪或现实检验的临床评估接受情况上存在差异（P = 0.044、P = 0.006和P = 0.002），在有精神科资源的急诊科记录的评估更多。就诊时缺乏简短咨询（无记录：儿科资源的急诊科为56.1%，精神科资源的急诊科为23.1%）；没有证据表明各地点在提供咨询方面存在差异。在有精神科资源的急诊科提供了更多的精神科会诊（34.1%对27.4%，P = 0.030）。两家急诊科都缺乏出院建议，但儿科资源的急诊科就诊的出院建议更不完整（P = 0.035）。
有儿科和精神科资源的急诊科缺乏对儿童心理健康就诊病例的一致和全面的临床管理。需要进行前瞻性评估，以确定当前急诊科临床实践对患者和家庭结局的影响，包括症状减轻和压力，以及随后的系统使用情况。
