Establishing best practice in pediatric emergency mental health: a prospective study examining clinical characteristics.
OBJECTIVE
The objectives of this prospective study were to determine the demographic and clinical characteristics of children and youth presenting to the emergency department (ED) for mental health concerns through the use of a valid standardized assessment protocol.


METHODS
Children and adolescents, 8 to 17 years, who presented to an ED-based crisis intervention program during fiscal years 2005 to 2006, completed self-report measures of depression, anxiety, and behavior. Clinicians completed the childhood acuity of psychiatric illness based on their assessment.


RESULTS
The clinician ratings indicated that 93.1% of the sample had at least 1 risk behavior or clinical symptom in the moderate/severe range. Admittance rate for the sample was 17.9% (low-risk admissions, 5.8%; high-risk deflections, 9%). Significant differences were found in presentations by sex and age as follows: (1) female youths (12-17 years) were more likely than male youth to report clinically significant depressive symptoms and to present with suicidal ideation/gesture and self-injury. (2) Male youths (12-17 years) were more likely to present with aggression to people/objects than female youth. (3) Male children younger than 12 years were more likely to present with high activity level than female children. Self-report measures (depression, anxiety, and behavior) corelated with corresponding clinician ratings.


CONCLUSIONS
This research, through the use of a multi-informant standardized assessment protocol, presents a comprehensive study of children and youth presenting to the ED with mental health issues. Identifying the clinical characteristics of this population is an important first step toward establishing best practice within an ED.
Kennedy
Allison
A
Mental Health Patient Service Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Akennedy@cheo.on.ca
Cloutier
Paula
P
Glennie
J Elizabeth
JE
Gray
Clare
C
D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D019985:Benchmarking; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D003419:Crisis Intervention / Q000458:organization & administration*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D004635:Emergency Medicine / Q000592:standards*; D004637:Emergency Services, Psychiatric / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011581:Psychological Tests; D012307:Risk Factors; D012309:Risk-Taking; D012647:Self-Assessment; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index