儿童精神科急诊结局与精神病理学维度的关系。
Association between child psychiatric emergency room outcomes and dimensions of psychopathology.
机构信息
Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, USA.
出版信息
Gen Hosp Psychiatry. 2019 Jul-Aug;59:1-6. doi: 10.1016/j.genhosppsych.2019.04.009. Epub 2019 Apr 16.
OBJECTIVE
To determine the degree to which dimensional psychopathology predicts length of stay in an emergency department (ED) and need for hospital admission among children with psychiatric complaints.
METHOD
Electronic health records of children age 4-17 years who presented to the ED of a large academic medical center were analyzed using a natural language processing tool to estimate Research Domain Criteria (RDoC) symptom scores. These scores' association with length of stay and probability of admission versus discharge to home were evaluated.
RESULTS
We identified 3061 children and adolescents who presented to the ED and were evaluated by the psychiatry service between November 2008 and March 2015. Median length of stay was 7.8 h (interquartile range 5.2-14.3 h) and 1696 (55.4%) were admitted to the hospital. Higher estimated RDoC arousal, cognitive, positive, and social domain scores were associated with increased length of stay in multiple regression models, adjusted for age, sex, race, private insurance, voluntary admission, and diagnostic categories. In similarly adjusted models, odds of hospital admission were increased by higher RDoC arousal and cognitive domain scores and decreased by higher negative domain scores.
CONCLUSIONS
A natural language processing tool to characterize dimensional psychopathology identified features associated with differential outcomes in children in the psychiatric ED, most notably symptoms reflecting arousal and cognitive function. Methodologically, this in silico approach to risk stratification should facilitate precision psychiatry in children within the emergency setting.
目的
确定多维精神病理学在多大程度上可以预测有精神科主诉的儿童在急诊科（ED）的住院时间和住院需求。
方法
使用自然语言处理工具分析了年龄在 4-17 岁之间、在大型学术医疗中心 ED 就诊的儿童的电子健康记录，以估计研究领域标准（RDoC）症状评分。评估这些评分与住院时间以及住院与出院的概率之间的关系。
结果
我们确定了 3061 名在 2008 年 11 月至 2015 年 3 月期间向 ED 就诊并由精神病科评估的儿童和青少年。中位住院时间为 7.8 小时（四分位间距为 5.2-14.3 小时），1696 人（55.4%）被收治住院。在多变量回归模型中，调整年龄、性别、种族、私人保险、自愿入院和诊断类别后，较高的估计 RDoC 唤醒、认知、阳性和社会领域评分与住院时间延长相关。在类似调整的模型中，RDoC 唤醒和认知领域评分较高与住院几率增加有关，而负面领域评分较高与住院几率降低有关。
结论
用于描述多维精神病理学的自然语言处理工具确定了与精神科 ED 中儿童不同结局相关的特征，最显著的是反映觉醒和认知功能的症状。从方法学上讲，这种基于计算的风险分层方法应该能够促进儿童在急诊环境中的精准精神病学。
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