title: Clinical acuity of repeat pediatric mental health presentations to the emergency department.
abstract: OBJECTIVE
  We examined whether clinical acuity changed in children and youth with repeated emergency department (ED) visits for mental illness. A secondary, exploratory objective was to examine characteristics associated with clinical acuity.
  
  
  METHODS
  We conducted a four-year historical cohort study reviewing data from 1,033 ED presentations by 474 patients (≤17 years) for mood disorders, neurotic/stress-related disorders, and psychosis-related illnesses. We used a multivariable generalized linear mixed model to examine the relationship between clinical acuity (defined by triage level at presentation) and length of time since initial ED visit. Interactions between diagnosis group and age group, sex, and visiting timing were also examined. Explanatory variables (patient demography, diagnosis, disposition, institutional classification and location) were entered into the model to explore their relationship to clinical acuity.
  
  
  RESULTS
  Clinical acuity did not change between ED visits for children with mood disorders, neurotic/stress-related disorders, or psychosis-related illnesses. The median time to ED return was 7 days. Several characteristics were associated with a higher likelihood of increased clinical acuity at presentation: being male, presenting to the ED with a mood disorder, and attendance to an urban-based ED.
  
  
  CONCLUSIONS
  Repeat ED visits for several pediatric mental illnesses were not a result of destabilized conditions. Further investigation of the relationship between patient characteristics, available community services, and patterned mental health care use is needed to clarify ED utilization patterns.
authors.affiliation: Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
authors.forename: Andrea Y
authors.initials: AY
authors.lastname: Yu
authors.forename: Rhonda J
authors.initials: RJ
authors.lastname: Rosychuk
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton