Hoffmann Jennifer A, Foster Ashley A, Gable Christopher J, Carlin Kristen E, Pergjika Alba, Burkhart Kimberly, Schultz Theresa R, Mullins Sara, Edemba Desiree, Saidinejad Mohsen
Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
J Am Coll Emerg Physicians Open. 2025 May 27;6(4):100180. doi: 10.1016/j.acepjo.2025.100180. eCollection 2025 Aug.
Children awaiting psychiatric hospitalization in the emergency department (ED) may experience prolonged boarding when no appropriate bed is available. Many recent studies of pediatric mental health boarding have focused on children's hospitals. Thus, we aimed to determine characteristics associated with boarding among pediatric mental health ED visits in a nationally representative sample.
This retrospective cross-sectional study examined mental health ED visits by children 5 to 17 years old using the 2018-2022 National Hospital Ambulatory Medical Care Survey, which uses probability sampling to generate national estimates. Survey-weighted multivariable logistic regression examined the association between visit characteristics and boarding, defined as visit length ≥12 hours.
Of 5,900,704 estimated pediatric mental health ED visits nationally (42.9% 15-17 years old, 56.4% female), 25.2% resulted in admission or transfer, and, of those, 32.1% had length ≥12 hours. Adjusted odds radio (aOR) of boarding were lower for visits by 10 to 14-year-olds (aOR, 0.19; 95% CI: 0.05, 0.70) than 15- to 17-year-olds, for visits by patients identifying as non-Hispanic other (aOR, 0.06; 95% CI: 0.01, 0.72) than non-Hispanic White, for visits with private insurance (aOR, 0.31; 95% CI: 0.10, 0.95) relative to public insurance, and for visits on weekends (aOR, 0.27; 95% CI: 0.08, 0.91) compared with weekdays.
Approximately 1 in 3 pediatric mental health ED visits resulting in admission or transfer exceeded 12 hours. Differences in boarding by race, ethnicity, and insurance type reflect inequities in access to psychiatric services. To reduce ED boarding, attention is needed to improve children's access to mental health services across the care continuum.
在急诊科等待精神科住院治疗的儿童，若没有合适床位，可能会经历长时间的滞留。近期许多关于儿科心理健康滞留的研究都集中在儿童医院。因此，我们旨在确定在全国代表性样本中，儿科心理健康急诊就诊中与滞留相关的特征。
这项回顾性横断面研究使用2018 - 2022年全国医院门诊医疗调查，对5至17岁儿童的心理健康急诊就诊情况进行了检查，该调查采用概率抽样来生成全国估计数据。调查加权多变量逻辑回归分析了就诊特征与滞留之间的关联，滞留定义为就诊时间≥12小时。
全国估计有5900704次儿科心理健康急诊就诊（42.9%为15 - 17岁，56.4%为女性），25.2%的就诊导致住院或转院，其中32.1%的就诊时间≥12小时。10至14岁儿童就诊的滞留调整优势比（aOR）低于15至17岁儿童（aOR，0.19；95%CI：0.05，0.70）；与非西班牙裔白人相比，非西班牙裔其他种族患者就诊的滞留调整优势比（aOR，0.06；95%CI：0.01，0.72）；相对于公共保险，有私人保险的患者就诊的滞留调整优势比（aOR，0.31；95%CI：0.10，0.95）；与工作日相比，周末就诊的滞留调整优势比（aOR，0.27；95%CI：0.08，0.91）。
约三分之一导致住院或转院的儿科心理健康急诊就诊时间超过12小时。种族、民族和保险类型在滞留方面的差异反映了获得精神科服务的不平等。为减少急诊科滞留，需要关注改善儿童在整个护理连续过程中获得心理健康服务的机会。
