Urgent Psychiatric Consults for Children Under 12 Years of Age: Reducing Pressure On Paediatric Emergency Rooms (ER).

Abstract

The last decade has seen a significant increase in presentations for mental health problems to paediatric ER, at least 5% of these visits are for mental health problems, most commonly suicide and aggression. Pediatricians identify their lack of training in treating this population. The Aimof this study was to a) examine the utilization of urgent consults by pediatricians for under 12-year olds b) study factors that make referrals urgent. c) Examine the impact on ED visits, referrals to psychiatric Ambulatory clinics. Method This is a 6 month outcome study of children referred from the pediatric ED for urgent psychiatric consult at a university hospital. Data was gathered on demographic variables, reason for referral, presenting complaints, developmental variables and Family history, previous diagnosis, treatments, psychiatrists diagnosis and disposition, admission rates, ER visits and referral to other psychiatric clinics. Paediatricians provided feedback. Data analysis was conducted using descriptive statistics. Results Common reason for referral was aggression, grade 3 males predominated, the commonest diagnosis was ADHD/ADD followed by anxiety disorder. 67% had previous diagnosis and had a trial of medication, more than a quarter had LD, positive family history for ADHD/ADD or antisocial PD. There was 67% agreement between Pediatrician and psychiatrist on diagnosis. Conclusion Amongst children that present to pediatric ER, there are a number of children who, by virtue of their neurodevelopmental vulnerabilities and consequent emotionla/behavioral dyscontrol, require expediated psychiatric assessment and management. Timely access to this service reduces the need for ongoing hospital based services and presentation to ED.