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Determinants of Pediatric Psychiatry Length of Stay in 2 Urban Emergency Departments

Chakravarthy, Bharath MD, MPH*; Yang, Allen BS*; Ogbu, Uzor MD, PhD*; Kim, Carole BS*; Iqbal, Anum BS*; Haight, Joanna BS; Anderson, Craig MPH, PhD*; DiMassa, Giancarlo MD*†; Bruckner, Tim PhD; Bhargava, Rishi MD; Schreiber, Merrit PhD*; Lotfipour, Shahram MD, MPH*

doi: 10.1097/PEC.0000000000000509
Original Articles

Objectives Pediatric mental illness poses a significant burden with an overall prevalence of approximately 10%. Increasingly, children with mental disorders seek care in the emergency department (ED). However, the ED is not an ideal setting. Pediatric mental health patients receive limited treatment and experience significantly longer length of stay (LOS) than other patients seen in the ED. This study examines patient and hospital factors associated with LOS and prolonged LOS (PLOS).

Methods This is a retrospective chart review of patients between the ages of 3 and 17 presenting at 2 participating urban EDs with a psychiatric diagnosis from May 2010 to May 2012.

Results This study includes 939 patients with an average age of 14.1 years and a median LOS of 295 minutes. The diagnosis was the strongest predictor of LOS and PLOS. Patients with a psychotic disorder or suicide attempt or ideation experienced a longer LOS, 35% and 55% increases, respectively, and an increased odds of PLOS (odds ratio, 3.07 and 8.36, respectively). Patient sex, previous history of self-harm, and the daily census were associated with both a longer LOS and PLOS. Ethnicity, site of admission, and year of admission were only associated with LOS.

Conclusions Diagnosis-specific management factors are the primary determinant of LOS. However, some patient characteristics and hospital operational factors are also associated with LOS. Organizational reforms and an evaluation of the required human and material resources are necessary to improve access to and availability of pediatric mental health care.

From the *Department of Emergency Medicine, University of California, Irvine Health School of Medicine, Orange; †Department of Emergency Medicine, Long Beach Memorial Medical Center, Long Beach; and ‡Department of Social Ecology, University of California Irvine, Irvine, CA.

Disclosure: The authors declare no conflict of interest.

Reprints: Bharath Chakravarthy, MD, MPH, Department of Emergency Medicine, University of California, Irvine, 101 The City Drive South, Rte 128-01, Orange, CA 92868 (e-mail:

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