To analyze the characteristics of pediatric mental health-related and suicide-related emergency department visits in relation to the volume of pediatric visits at the ED.
Approach:
Study Design: Retrospective cross-sectional exploratory study using the 2016 to 2022 Nationwide Emergency Department Sample (NEDS).
Population: Pediatric patients aged 5 to 17 years with a primary mental health diagnosis.
Data Analysis: Included approximately 5.4 million weighted mental health-related ED visits, with multivariable analyses examining associations with various demographic and clinical factors.
Key Findings:
50% of pediatric mental health-related ED visits occurred at high-volume EDs, while the other 50% were at lower-volume EDs, including 5% at low-volume EDs, 21% at medium-volume EDs, and 24% at medium-high-volume EDs.
Patients aged 15 to 17 years accounted for 49% of visits, with 58% involving female patients.
Suicide or self-injury was the most frequent diagnosis at 24%, followed by depressive disorders at 23%.
Mental health-related ED visits increased by 24% from 2016 to 2022, while suicide-related visits increased by 74%.
Non-Hispanic Black and Hispanic patients had higher odds of presenting to high-volume EDs compared to non-Hispanic White patients.
Interpretation:
The study highlights that a significant proportion of pediatric mental health-related and suicide-related visits occur in lower-volume EDs, which may lack adequate mental health resources.
Limitations:
NEDS does not include patient-level identifiers, limiting the ability to account for patient-level clustering.
Administrative coding may have misclassified demographic characteristics and diagnoses.
Race and ethnicity data were unavailable for nearly half of the study period, which may affect the generalizability of the findings.
Data did not capture adverse childhood experiences or neighborhood-level factors.
Conclusion:
The findings indicate that approximately half of pediatric mental health-related and suicide-related ED visits occur outside high-volume pediatric EDs, with variations based on race, ethnicity, and diagnosis.
