Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. An analysis of emergency department (ED) visits across the United States between 2007 and 2017 showed a 60% overall increase in ED visits among children 5-17 years old with mental health diagnoses, including significant increases in these visits at nonchildren’s EDs and rural EDs.

2. Children’s ED visits for deliberate self-harm more than tripled, and visits for all substance use disorders increased while visits for alcohol-related disorders decreased.

Evidence Rating Level: 3 (Average)

Study Rundown:

Previous studies have shown that many hospital EDs, especially those in rural areas and those that see small numbers of children, are less likely to be prepared to treat children and have worse outcomes. ED visits for children with mental health disorders have been rising, and few studies have examined the characteristics of the EDs in which these children seek care. In this cross-sectional study, researchers used national ED database data to examine trends in ED visits made by children with a mental health disorder, stratified by hospital ED characteristics. Between 2007 and 2016, while total pediatric ED visits remained stable, pediatric ED visits for all mental health disorders rose by 60%. ED visits for deliberate self-harm more than tripled. The increased rate of pediatric mental health visits was greatest among high-pediatric-volume EDs and EDs in metropolitan areas, though increases were significant across EDs with nearly all volumes of pediatric patients and in EDs in both urban and rural settings.

These findings are limited by the database, which did not include data on the primary diagnosis code for ED visits, and which only included ~20% of EDs in the US. Furthermore, mental health conditions may have been missed if the patient did not have the diagnosis before presentation to the ED. Nonetheless, the study is strengthened by its large, nationally representative sample of emergency departments and examination of hospital characteristics. For physicians, these findings highlight the importance of advocating for improved ED preparedness for mental health conditions and emergencies, especially in rural EDs with low pediatric patient volume.

In-Depth [cross-sectional study]:

Researchers used data from the 2007 to 2016 Nationwide Emergency Department Sample databases to describe trends in the number of ED visits made by children (5-17 years) with a mental health disorder. Diagnoses were identified using billing code data, and hospitals were classified by pediatric ED volume and size of metropolitan area. Differences between rates were analyzed using t tests.

During the study period, pediatric ED visits for all mental health disorders rose by 60% (P < 0.001) while total pediatric ED visits were stable. Anxiety disorders increased by 117% (P < 0.001), impulse control disorders increased by 111% (P < 0.001), and all substance use disorders increased by 75% (P < 0.001), while alcohol-related disorders decreased by 40% (P < 0.001). ED visits for deliberate self-harm increased by 329% (P < 0.001). Pediatric ED visits for mental health disorders significantly increased in EDs of nearly all volumes, in both urban and rural hospitals, and in both children’s hospital and nonchildren’s hospital EDs, though some of the largest increases were seen in EDs with high volume and in hospitals in metropolitan areas.

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