706 - Adolescent Psychiatric Emergencies Requiring Inpatient Hospitalizations after the COVID-19 Pandemic – Characteristics and Trends
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 706 Publication Number: 706.328
RIYA KALRA, Beaumont Children's Hospital, Troy, MI, United States; Margaret Menoch, Corewell Health East, Royal Oak, MI, United States; Andrea T. Scheid, Beaumont Children's, Royal Oak, MI, United States; Shashi Sahai, Beaumont Hospital, Troy, MI, United States
Pediatrics resident - 3rd year Beaumont Children's Hospital Troy, Michigan, United States
Background: Pediatric psychiatric crisis was pushed to the forefront during the COVID-19 pandemic. Emergency departments (ED) and inpatient pediatric hospitals saw much higher volumes of mental health complaints, with many patients staying in these places until definitive care was available. Objective: Evaluate pediatric psychiatric ED visits and hospital admissions since the start of COVID-19 pandemic to identify the high-risk features of the patients who needed inpatient psychiatric hospitalization. Design/Methods: Retrospective chart review of ED and inpatient visits from 3/9/2020 to 2/28/2022 of adolescents aged 13-18-years with any of the following diagnoses: depression, anxiety, suicide attempt, conversion, eating, bipolar and panic disorders, schizophrenia, substance abuse, attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder. Charts were manually reviewed for disposition to an inpatient psychiatric facility. Information extracted was patient demographics, home medications and compliance, attendance in therapy and other factors affecting mental health. Results: Total pediatric psychiatric encounters were 4,663 (20% of the total encounters for all ailments). 53% were female, 47% were male; 18.8% (highest) were 17 years old; 72% were Caucasian, 7% were African American, 1% were American Indian, 1% were Asian, and 19% did not specify their race. 8.5% (400) were discharged to an inpatient pediatric psychiatric facility. We attempted to review these 400 charts but only 371 could be reviewed due to restricted access. Out of these 371, 66% were females, 34% were males, and 22% (highest) were 17 years old. The 4 major diagnoses identified were: Depression 81.5%, Anxiety 38.3%, ADHD 10% and Bipolar disorder 8%. 54% had a history of prior psychiatric hospitalization, 70% were already on prescribed psychiatric medications, and 80.5% were undergoing outpatient psychological therapy. Only 31.2% were taking their psychiatric medications as prescribed and only 22.3% were attending their outpatient therapy sessions regularly. 71.6% reported suicidal ideations, 21.4% were admitted for suicide attempt, 16% were victims of physical, emotional, or sexual abuse, 2% were victims or witnesses to bullying, 5.1% had an eating disorder requiring nutritional rehabilitation, 10% had associated psychosis and 9% had developmental delay.
Conclusion(s): There is a high incidence of needing repeat inpatient psychiatric care in high-risk adolescents as their compliance with medications and therapy is low. Identifying the gaps in care presents an opportunity for reducing the need for inpatient psychiatric care.
