From the St David Medical Center, Austin.
Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin Odessa, TX.
J ECT. 2021 Jun 1;37(2):100-106. doi: 10.1097/YCT.0000000000000750.
Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay.
Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ≤18 years) undergoing ECT in the United States using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification/Procedure Coding System codes and compared with non-ECT C/A patients with the same primary diagnosis. Baseline clinical characteristics were assessed using descriptive analysis methods. Multilevel regression analysis and trend analysis were performed.
Children and adolescent patients (n = 159,158) receiving (ECT: n = 1870) were more likely to be men (43.3% vs 36.7%) and of White race (58% vs 49%) (P < 0.001). The hospital stay was longer (19 days vs 6 days, P < 0.001) for the ECT group than controls. ECT receiving C/A patients were more likely to have private insurance (72% vs 42%, P < 0.001). African American patients undergoing ECT treatment increased in number over the course of years (2002 to 2017), whereas the privately insured C/A patients receiving ECT decreased over the same period (P < 0.001). There was an upward trend in ECT utilization for small bed size hospitals (P < 0.001). Length of stay for C/A receiving ECT was longer for males (P < 0.001) and patients with nonprivate insurance (p: 0.003).
Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.
电抽搐治疗（ECT）在儿童和青少年（C/A）中存在争议。本研究的主要目的是评估与具有相同主要适应证的非 ECT 组相比，C/A 患者在使用 ECT 时的基线特征。次要目的是评估 16 年来 ECT 使用率的变化趋势，并探讨住院时间的预测因素。
使用 2002 年至 2017 年全国住院患者样本数据库，我们使用国际疾病分类第 9 版和第 10 版临床修正/程序编码系统代码在美国确定接受 ECT 的患者（年龄≤18 岁），并将其与具有相同主要诊断的非 ECT C/A 患者进行比较。使用描述性分析方法评估基线临床特征。进行多水平回归分析和趋势分析。
接受 ECT（ECT：n=1870）的儿童和青少年患者（n=159158）更可能是男性（43.3%比 36.7%）和白人（58%比 49%）（P<0.001）。ECT 组的住院时间较长（19 天比 6 天，P<0.001）。ECT 组的 C/A 患者更可能有私人保险（72%比 42%，P<0.001）。在研究期间，接受 ECT 治疗的非裔美国患者人数有所增加（2002 年至 2017 年），而同期接受 ECT 治疗的私人保险 C/A 患者人数有所减少（P<0.001）。小床医院 ECT 使用率呈上升趋势（P<0.001）。接受 ECT 的 C/A 患者中，男性（P<0.001）和非私人保险患者（p：0.003）的住院时间更长。
ECT 在 C/A 中并未得到最佳应用，因此需要制定治疗指南。
