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Epidemiology of Psychiatric-Related Visits to Emergency Departments in a Multicenter Collaborative Research Pediatric Network

Mahajan, Prashant MD, MPH, MBA*; Alpern, Elizabeth R. MD, MSCE†; Grupp-Phelan, Jackie MD, MPH‡; Chamberlain, James MD§; Dong, Lydia MS∥; Holubkov, Richard PhD∥; Jacobs, Elizabeth MD§; Stanley, Rachel MD, MHSA¶; Tunik, Michael MD#; Sonnett, Meridith MD**; Miller, Steve MD**†; Foltin, George L. MD#; Pediatric Emergency Care Applied Research Network (PECARN)

doi: 10.1097/PEC.0b013e3181bec82f
Original Articles

Objectives: Describe the epidemiology of pediatric psychiatric-related visits to emergency departments participating in the Pediatric Emergency Care Applied Research Network.

Methods: Retrospective analysis of emergency department presentations for psychiatric-related visits (International Classification of Diseases, Ninth Revision, codes 290.0-314.90) for years 2003 to 2005 at 24 participating Pediatric Emergency Care Applied Research Network hospitals. All patients who had psychiatric-related emergency department visits aged 19 years or younger were eligible. Age, sex, race, ethnicity, insurance status, mode of arrival, length of stay, and disposition were described for psychiatric-related visits and compared with non-psychiatric-related visits.

Results: Pediatric psychiatric-related visits accounted for 3.3% of all participating emergency department visits (84,973/2,580,299). Patients with psychiatric-related visits were older (mean ± SD age, 12.7 ± 3.9 years vs. 5.9 ± 5.6 years, P < 0.001), had a higher rate ambulance arrival (19.4% vs 8.2%, P < 0.0001), had a longer median length of stay (3.2 vs 2.1 hours, P < 0.0001), and had a higher rate of admission (30.5% vs 11.2%, P < 0.0001) when compared with non-psychiatric-related patient presentations. Older age, female sex, white race, ambulance arrival, and governmental insurance were factors independently associated with admission or transfer from the emergency department for psychiatric-related visits in multivariate regression analyses.

Conclusions: Pediatric psychiatric-related visits require more prehospital and emergency department resources and have higher admission/transfer rates than non-psychiatric-related visits within a large national pediatric emergency network.

From the *Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan & Wayne State University, Detroit, MI; †Children's Hospital of Philadelphia, PA; ‡Cincinnati Children's Hospital Medical Center, OH; §Children's National Medical Center, Washington, DC; ∥University of Utah, Salt Lake City, UT; ¶University of Michigan, Ann Arbor, MI; #Bellevue Hospital Center, New York, NY; and **Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY.

Reprints: Prashant Mahajan, MD, MPH, MBA, Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan & Wayne State University, 3901 Beaubien, Detroit, MI 48201 (e-mail: pmahajan@dmc.org).

†Dr. Miller died October 19, 2004.

The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the Emergency Medical Services for Children (EMSC) program of the Maternal and Child Health Bureau, Health Resources and Services Administration, and US Department of Health and Human Services.

© 2009 Lippincott Williams & Wilkins, Inc.