Abstract
BACKGROUND AND OBJECTIVES: Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS: We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS: From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS .6 hours) and 5.3% to 12.7% (LOS .12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS .12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS: The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
| Original language | English (US) |
|---|---|
| Article number | e2020030692 |
| Journal | Pediatrics |
| Volume | 147 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2021 |
Funding
FUNDING: This publication was made possible by the National Clinician Scholars Program and the Clinical and Translational Science Award grant TL1 TR001864 from the National Center for Advancing Translational Science, a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NIH. Dr Venkatesh reports support of the American Board of Emergency Medicine–National Academy of Medicine Anniversary Fellowship and previous support of award KL2 TR001862 from the National Center for Advancing Translational Science, a component of the NIH. The funders/sponsors did not participate in the work. Dr Hoffmann reports support from the US Agency for Healthcare Research and Quality (5K12HS026385-03). Funded by the National Institutes of Health (NIH).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health