Dr. Gerson and Dr. Havens are with the Department of Child and Adolescent Psychiatry, Bellevue Hospital Center, New York. They are also with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, where Ms. Lee, Dr. Liu, and Dr. Horwitz are affiliated. Ms. Marr is with the Department of Behavioral Neuroscience, Oregon Health and Science University, Portland. Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Rojas Marcos is with the School of Public Health, George Washington University, Washington, D.C.
Psychiatr Serv. 2017 Nov 1;68(11):1104-1111. doi: 10.1176/appi.ps.201600436. Epub 2017 Jun 15.
Most youths experiencing a psychiatric crisis present to emergency departments (EDs) that lack the specialized staff to evaluate them, so youths are often discharged without appropriate mental health assessment or treatment. To better understand the needs of this population, this study described clinical details and disposition associated with visits for psychiatric emergencies to a specialized ED staffed 24/7 by child psychiatrists.
Through retrospective chart review, 1,180 visits to the ED during its first year of operation were reviewed for clinical characteristics, prior service utilization, and demographic characteristics. Bivariate analyses (chi-square test and Wilcoxon rank sum test) compared differences in disposition (evaluate and release, brief stabilization, and inpatient psychiatric admission) associated with characteristics of the children's first visit (N=885). Measures with bivariate association of p<.10 were further assessed by using multinomial logistic regression analyses.
For most visits (59%), children were evaluated and released, 13% were briefly stabilized, and 28% were admitted for psychiatric treatment. Youths with mood or psychotic disorders were more likely to be admitted, as were those with current suicidality or aggression. Many youths who presented with aggression were also identified as having suicidality or self-harm.
Clinical factors, especially suicidality, predicted psychiatric admission. Admission rates for youths with suicidality were significantly higher in this study than previously reported, suggesting the availability of child psychiatrists in this ED allowed greater ascertainment of suicide risk (and thus hospitalization to mitigate that risk) than occurs in EDs without such staffing.
大多数经历精神科危机的年轻人会到缺乏专业人员进行评估的急诊部（ED）就诊，因此这些年轻人往往在没有适当的心理健康评估或治疗的情况下出院。为了更好地了解这一人群的需求，本研究描述了由儿童精神科医生 24/7 全天候配备的专门 ED 就诊的精神科急症的临床细节和处置情况。
通过回顾性病历审查，对 ED 运营第一年的 1180 次就诊进行了临床特征、既往服务利用情况和人口统计学特征的回顾。使用卡方检验和 Wilcoxon 秩和检验对与儿童首次就诊特征相关的处置（评估和释放、短暂稳定和住院精神科入院）差异进行了双变量分析（n=885）。具有双变量关联的 p<0.10 的指标进一步通过使用多项逻辑回归分析进行评估。
对于大多数就诊（59%），儿童被评估和释放，13%被短暂稳定，28%被收治进行精神科治疗。患有心境或精神病性障碍的年轻人更有可能被收治入院，目前有自杀意念或攻击性的年轻人也是如此。许多表现出攻击性的年轻人也被认为有自杀意念或自残行为。
临床因素，尤其是自杀意念，预测了精神科收治。本研究中，有自杀意念的年轻人的收治率明显高于之前的报告，这表明 ED 配备儿童精神科医生可以更准确地确定自杀风险（从而通过住院治疗来降低风险），而在没有这种人员配备的 ED 中，这种情况则更为少见。
