Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
J Pediatr. 2020 Apr;219:54-61.e1. doi: 10.1016/j.jpeds.2019.12.046. Epub 2020 Feb 24.
To evaluate the utility of universal psychosocial screening in the emergency department (ED) using MyHEARTSMAP, a digital self-assessment and management guiding tool.
We conducted a cohort study of youth 10-17 years of age with nonmental health related presentations at 2 pediatric EDs. On randomly selected shifts (December 2017-February 2019), participants completed their psychosocial self-assessments using MyHEARTSMAP on a mobile device, then underwent a standardized clinical mental health assessment (criterion standard). We reported the sensitivity and specificity of respondents' self-assessment, against a clinician's standard emergency psychosocial assessment, and the frequency of psychosocial issues and recommended mental health resources identified by screening.
We approached 1432 eligible youth, among which 795 youth consented to participate (55.5%). Youth and guardians' sensitivity at self-identifying psychiatric concerns was 92.7% (95% CI 89.1, 95.4%) and 93.1% (95% CI 89.5, 95.8%), respectively. In cases where clinicians had determined to be no psychiatric issues, 98.5% (95% CI 96.7, 99.4%) of youth and 98.9% (95% CI 97.3, 99.7%) of guardians identified the youth as having no or only mild issues. Screening identified 36.4% of youth as having issues in at least 1 psychosocial domain which warranted further follow-up.
Psychosocial screening in EDs using MyHEARTSMAP can reliably be conducted using the MyHEARTSMAP self-assessment tool and over one-third of screened youth identified issues which can be directed to further care.
使用 MyHEARTSMAP(一种数字自我评估和管理指导工具)评估急诊科(ED)中普遍进行心理社会筛查的效用。
我们对 2 家儿科 ED 中因非心理健康相关问题就诊的 10-17 岁青少年进行了队列研究。在随机选择的班次(2017 年 12 月至 2019 年 2 月)中,参与者使用移动设备完成 MyHEARTSMAP 的心理社会自我评估,然后进行标准化的临床心理健康评估(标准)。我们报告了受访者自我评估的敏感性和特异性,与临床医生的标准急诊心理社会评估相对,并报告了筛查发现的心理社会问题和推荐心理健康资源的频率。
我们接触了 1432 名符合条件的青少年,其中 795 名青少年同意参与(55.5%)。青少年和监护人自我识别精神问题的敏感性分别为 92.7%(95%CI 89.1,95.4%)和 93.1%(95%CI 89.5,95.8%)。在临床医生确定没有精神问题的情况下,98.5%(95%CI 96.7,99.4%)的青少年和 98.9%(95%CI 97.3,99.7%)的监护人认为青少年没有或只有轻度问题。筛查发现,至少有 1 个心理社会领域存在问题的青少年占 36.4%,需要进一步随访。
使用 MyHEARTSMAP 在 ED 中进行心理社会筛查可以可靠地使用 MyHEARTSMAP 自我评估工具进行,超过三分之一的筛查青少年发现存在问题,可进一步指导护理。