398 - Quality of Life for Children with Mental and Behavioral Health Emergencies who Board in the Pediatric Emergency Department
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 398 Publication Number: 398.231
Nina Friedman, NewYork-Presbyterian Komansky Children’s Hospital, New York City, NY, United States; Nicole Gerber, Weill Cornell Medicine, New York, NY, United States; Kathleen Morton, Weill Cornell Medicine, Brooklyn, NY, United States; Brady Rippon, Weill Cornell Medicine, Astoria, NY, United States; Ho Kyeong Jang, Weill Cornell Medicine, New York, NY, United States; Shari Platt, Weill Cornell Medicine, New York, NY, United States; Lois K. Lee, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
Certified Child Life Specialist NewYork-Presbyterian Komansky Children’s Hospital New York City, New York, United States
Background: Patients with mental and/or behavioral health (MBH) emergencies frequently board in emergency departments (ED) for greater than 24 hours. Little is understood about the effects of ED boarding on the quality of life (QoL) for these MBH patients. Objective: To evaluate the QoL of MBH patients compared to non-MBH patients in the Pediatric ED (PED). Design/Methods: This is a prospective, observational study of patients 8-17 years old presenting to the PED of an urban tertiary care hospital from December 2021 to December 2022. We assessed patients’ and caregivers’ perception of patient QoL using the PedsQL™ Present Functioning Visual Analogue Scale (PedsQL™ VAS), a validated scale comprised of six items (fear, sadness, anger, worry, fatigue, and pain) and averaged into a total symptom score (range 0-100). Higher scores signify increased mental distress. We also examined the Emotional Distress Summary Score, a subset of the total score, comprised of four items (anxiety, sadness, anger, worry). We compared p</span>atients presenting with MBH to those with non-MBH complaints, either an extremity injury or with a chronic medical condition (e.g. cancer, kidney/inflammatory bowel/heart disease) at ED presentation and prior to ED disposition. Median PedsQL™ VAS Total Symptom Scores with interquartile ranges (IQR) were calculated for patients’ and caregivers’ perception of patient QoL. The chi-square statistic compared patient characteristics and the Wilcoxon rank sum test compared QoL scores between MBH and non-MBH patients. Results: We enrolled 112 MBH and 111 control patient-caregiver dyads (Figure). MBH compared to non-MBH patients were more likely to be female (69% vs. 35%, p < 0.01) and identify as LGBTQ+ (66% vs. 50%, p < 0.05). They also had a longer ED LOS (30 hrs. vs. 3 hrs.) (Table 1). MBH compared to non-MBH patients had higher distress as measured by higher QoL median scores at presentation (54 vs. 40, p < 0.001) and disposition (49 vs. 24, p < 0.001). MBH patients had less improvement in QOL scores over time compared to non-MBH patients (-3 vs. -10, p < 0.001). Emotional Distress Summary Scores were also higher in MBH patients. Similar trends were seen for caregivers’ perceptions of patients’ QoL at presentation and disposition (Table 2).
Conclusion(s): Mental and behavioral health patients in the PED have higher distress at both presentation and disposition. Compared to non-MBH patients the QoL of MBH patients does not improve while in the PED. Efforts to improve QoL for boarding pediatric MBH patients, such as initiating therapeutic management, may improve the emergency care for these patients.
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