351 - Chief Complaints of Youth Presenting to the Emergency Department Who Receive a Mental Health Diagnosis

Many children presenting to the Emergency Department (ED) for reasons unrelated to mental health may still have unrecognized mental health needs. Over the past decade, there has been a significant increase in the number of pediatric ED visits with mental health-related discharge or admission diagnoses. However, little is known about the primary reason these patients come to the ED.

Objective:

To describe the chief complaints of youth presenting to a pediatric ED who receive a mental health diagnosis at discharge or admission.

Design/Methods:

We conducted a single-center retrospective cohort study of 12 to 19 year old patients presenting to a pediatric ED between June 2013 and March 2020 who completed a self-administered mental health screen. This screen is offered as institutional standard-of-care. We categorized chief complaints as mental health-related if they described a specific DSM-5 diagnosis or symptom.  We identified each patient’s top three ED visit diagnoses and classified them as mental health-related using a previously validated scheme based on ICD-10 codes. We describe the relationship between mental health chief complaints and final ED diagnoses.

Results:

There were 24,458 unique ED visits for adolescents who completed mental health screening during the study period, of whom 21.6% (n=5,271) had a mental health-related diagnosis at ED discharge or admission. 65.1% of youth with a mental health-related discharge or admission diagnosis also had a mental health chief complaint (n=3,434). 33.4% of youth with a mental health-related discharge or admission diagnosis did not present with a mental health chief complaint (n=1,725).

The most common non-mental health chief complaint for youth who ultimately received a mental health diagnosis was non-specific (evaluation or parental concern; 18.3%, Table), followed by respiratory symptoms (asthma, dyspnea or respiratory distress; 10.9%); non-specific neurologic symptoms (dizziness, numbness, abnormal movements, altered mental status or amnesia; 10.2%); chest pain or tightness (9.7%); dehydration, malnutrition or weight loss (8.0%) and headache (7.0%). Overall, 2.3% of youth with a non-mental health chief complaint were admitted to the hospital with a mental health diagnosis.

Conclusion(s):

In this single-center study, 33.4% of youth who received an ED mental health diagnosis did not present with a mental health chief complaint. These patients had a wide range of presenting symptoms. This highlights the importance of mental health screening for all adolescents seen in the ED, irrespective of chief complaint, to connect youth with lifesaving treatment.