103 Mental Health Care for Pediatric Presentations to Emergency Departments: A scoping review

Approximately 20% of children suffer from mental health (MH) diagnoses in North America and many of these of these children seek care in emergency departments (ED). There are no current formalized recommendations or protocols to inform optimized clinical practice for managing children with mental health concerns in ED. To identify the state of services provided and strategies used to optimize care for children presenting to the ED with mental health concerns in North America. A systematic review was conducted using published literature from MEDLINE, EMBASE, PsycINFO, Cochrane and CINAHL from January 2007 to March 2017 to identify publications using MeSH terms for mental health, pediatrics and emergency department. Strict inclusion criteria were used to evaluate the 3450 papers that were identified, following duplicate removal. 17 studies were found to meet the inclusion criteria of – first, children <18 years of age presenting to emergency departments in North America with mental health concerns were the study population, secondly, the services provided to these patients and their treatment outcomes were included in the analyses and reporting. Studies were not excluded based on study design, while studies that were not available in English were excluded. 16 studies were found through the systematic review of the above listed databases, while one study was identified through consulting the reference lists from the 16 studies. Of the 23 studies, two described characteristics of children’s mental health presentations, one described patient and caregiver perceptions and expectations of emergency department (ED) care, two examined the current state of mental health services in EDs, six discussed care and outcomes such as length of stay, lab testing, admission or return visits, eight addressed self-harm in children with mental health issues presenting to the emergency department and four examined the impact of strategies aimed at improving care. These reports indicated that, mood/anxiety disorders and suicidal ideation were the most common ED presentations, while suicidality was the most common reason for subsequent hospital admission. Furthermore, the mental health services available for pediatric psychiatry assessments showed significant heterogeneity. The length of stay in the ED was found to be increased by several factors: a rural site, a presenting history of suicidal ideation or self-injurious behavior, and laboratory investigations as part of the ED assessment. Studies also consistently reported that adding mental health staff, such as psychiatric nurses, in the ED care did not increase the costs of care. Finally, staff surveys following these additions showed improved perception of patient satisfaction, process efficacy and patient safety. This review indicates length of stay and characterization of the demographics of pediatric patients presenting for MH concerns as priorities for the published literature. Further, that the services for this population needs to be further characterized, with only four studies being identified to evaluate optimization strategies. These reports suggest the importance of considering strategies such as adding MH workers to ED care as an important method to potentially improve patient care and family satisfaction.

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