Stanford Department of Emergency Medicine, Stanford CA.
Pediatr Emerg Care. 2022 Mar 1;38(3):e1075-e1081. doi: 10.1097/PEC.0000000000002590.
Pediatric emergency department (ED) mental health visits are increasing in the United States. At the same time, child/adolescent psychiatric services are limited. This study examines the trajectory of pediatric patients presenting with mental health emergencies to better understand availability of specialty care resources in regional networks.
This retrospective cohort study used a California Office of Statewide Health Planning and Development linked ED and Inpatient Discharge Dataset (2005-2015) to study pediatric patients (5-17 years) who presented to an ED with a primary mental health diagnosis. Outcomes were disposition: discharge, admission, or transfer.Patients transferred were further analyzed for disposition. Regression models to identify characteristics associated with disposition were created.
There were 384,339 pediatric patients presented for a primary mental health emergency from 2005 to 2015; 287,997 were discharged, 17,564 were admitted, and 78,725 were transferred. Among those not discharged, patients with public (odds ratio [OR], 1.28; P < 0.01) or self-pay insurance (OR, 5.64; P < 0.01), Black (OR, 2.15; P < 0.01), or Native American race (OR, 2.32; P < 0.01), and who presented to rural EDs (OR, 3.10; P < 0.01), nonteaching hospitals (OR, 3.06; P < 0.01), or hospitals in counties without dedicated child/adolescent psychiatric beds (OR, 5.59; P < 0.01) had higher odds of transfer.Among those not discharged from the second hospital, Black patients (OR, 2.47; P < 0.03) and those who were transferred to a teaching hospital (OR, 1.9; P < 0.01) had higher odds of second transfer.
Pediatric patients with mental health emergencies experience different trajectories of care. Transfer protocols and regionalized networks may help streamline services and decrease inefficiencies in care.
美国儿科急诊（ED）心理健康就诊量不断增加，而儿童/青少年精神病服务资源却有限。本研究旨在通过研究患有精神健康急症的儿科患者的就诊轨迹，更好地了解区域网络中专业护理资源的可用性。
本回顾性队列研究使用加利福尼亚州州立卫生规划与发展办公室（2005-2015 年）的急诊和住院患者出院数据集，研究因主要精神健康诊断而就诊于 ED 的儿科患者（5-17 岁）。结局是处置：出院、入院或转院。对转院患者进行进一步的转院处置分析。建立了回归模型，以确定与处置相关的特征。
2005 年至 2015 年期间，共有 384339 名儿科患者因主要精神健康急症就诊；287997 人出院，17564 人入院，78725 人转院。在未出院的患者中，有公共保险（优势比[OR]，1.28；P<0.01）或自付保险（OR，5.64；P<0.01）、黑人（OR，2.15；P<0.01）或美洲原住民（OR，2.32；P<0.01）、在农村 ED 就诊（OR，3.10；P<0.01）、非教学医院（OR，3.06；P<0.01）或所在县无专用儿童/青少年精神病床位的医院（OR，5.59；P<0.01）的患者，其转院的可能性更高。在第二次住院未出院的患者中，黑人患者（OR，2.47；P<0.03）和转往教学医院的患者（OR，1.9；P<0.01）的再次转院可能性更高。
患有精神健康急症的儿科患者经历了不同的治疗轨迹。转移协议和区域化网络可能有助于简化服务并减少护理中的低效率。
