Factors associated with boarding and length of stay for pediatric mental health emergency visits

Jennifer A Hoffmann*, Anne M. Stack, Michael C. Monuteaux, Romy Levin, Lois K. Lee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Objective: To determine demographic and clinical risk factors associated with boarding (length of stay ≥24 h) for pediatric mental health emergency department (ED) visits. Methods: This is a retrospective cross-sectional analysis of mental health visits identified by diagnosis codes for children 5–18 years old presenting to a tertiary pediatric ED in 2016. We performed multivariate logistic regression to identify demographic and clinical factors associated with boarding. Results: There were 1746 mental health visits and 386 (22%) visits had length of stay ≥24 h. In the multivariate logistic regression model, factors associated with boarding included: private insurance (OR 1.59, 95% CI 1.15, 2.19) and having both private and public insurance (OR 1.68, 95% CI 1.16, 2.43) relative to public insurance; presentation during a school month (OR 2.17, 95% CI 1.30, 3.63); physical or chemical restraint use (OR 4.80, 95% CI 2.61, 8.84); comorbid autism or developmental delay (OR 1.82, 95% CI 1.35, 2.46); prior psychiatric hospitalization (OR 2.55, 95% CI 1.93, 3.36); and reasons for presentation of agitation, aggression, or homicidal ideation (OR 2.76, 95% CI 1.40, 5.45), depression, self-injury, or suicidal ideation (OR 2.79, 95% CI 1.45, 5.40), and bipolar, mania, or psychosis (OR 5.78, 95% CI 2.36, 14.09) relative to anxiety. Conclusions: Insurance status, presentation month, restraint use, autism or developmental delay comorbidity, prior psychiatric hospitalization, and reason for presentation are associated with pediatric mental health ED boarding. Resources should be directed to improve the mental health care system for children with identified risk factors for boarding.

Original languageEnglish (US)
Pages (from-to)1829-1835
Number of pages7
JournalAmerican Journal of Emergency Medicine
Issue number10
StatePublished - Oct 2019


  • Emergency department
  • Length of stay
  • Mental health boarding

ASJC Scopus subject areas

  • Emergency Medicine


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