Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study

Jennifer A Hoffmann; Camille P Carter; Cody S Olsen; David Ashby; Kamali L Bouvay; Susan J Duffy; James M Chamberlain; Sofia S Chaudhary; Nicolaus W Glomb; Jacqueline Grupp-Phelan; Maya Haasz; Erin P O'Donnell; Mohsen Saidinejad; Bashar S Shihabuddin; Leah Tzimenatos; Neil G Uspal; Joseph J Zorc; Lawrence J Cook; Elizabeth R Alpern; PECARN Registry Study Group

doi:10.1111/acem.14910

Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study

Acad Emerg Med. 2024 Aug;31(8):739-754. doi: 10.1111/acem.14910. Epub 2024 Apr 2.

Authors

Jennifer A Hoffmann¹, Camille P Carter², Cody S Olsen², David Ashby³, Kamali L Bouvay⁴, Susan J Duffy^{5

6}, James M Chamberlain⁷, Sofia S Chaudhary⁸, Nicolaus W Glomb⁹, Jacqueline Grupp-Phelan⁹, Maya Haasz¹⁰, Erin P O'Donnell¹¹, Mohsen Saidinejad¹², Bashar S Shihabuddin¹³, Leah Tzimenatos¹⁴, Neil G Uspal¹⁵, Joseph J Zorc¹⁶, Lawrence J Cook², Elizabeth R Alpern¹; PECARN Registry Study Group

Affiliations

¹ 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.
² Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
³ Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
⁴ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
⁵ Department of Emergency Medicine, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA.
⁶ Department of Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA.
⁷ Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA.
⁸ Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁹ Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
¹⁰ Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA.
¹¹ Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹² Department of Emergency Medicine, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
¹³ Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
¹⁴ Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA.
¹⁵ Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
¹⁶ Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 38563444
DOI: 10.1111/acem.14910

Abstract

Background: The COVID-19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID-19 pandemic differed from expected prepandemic trends.

Methods: We retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017-February 2020), early pandemic (March 2020-December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics.

Results: We identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78-0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96-1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86-0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02-1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38-2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10-2.59), and substance-related and addictive disorders (RR 1.50, 95% CI 1.18-2.05).

Conclusions: During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.

Publication types

Multicenter Study

MeSH terms

Adolescent
COVID-19* / epidemiology
Child
Child, Preschool
Emergency Room Visits
Emergency Service, Hospital* / statistics & numerical data
Female
Humans
Male
Mental Disorders / epidemiology
Mental Disorders / therapy
Pandemics
Retrospective Studies
SARS-CoV-2
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding