title: Occult psychosocial impairment in a pediatric emergency department population.
abstract: OBJECTIVE
  We compared the degree of psychosocial impairment in patients seen in the emergency department (ED) for acute complaints with that of patients presenting with chronic complaints using the Youth Pediatric Symptom Checklist (PSC-Y). Our hypothesis was that patients with multiple visits for chronic complaints (>3 health care visits for the chief complaint during the previous 12 months) would be more likely than patients with acute complaints to test positive for psychosocial issues.
  
  
  METHODS
  The PSC-Y was administered to patients aged 8 to 18 years presenting to a pediatric ED for nonpsychiatric complaints. We compared proportions of patients testing positive for psychosocial impairment on the PSC-Y or any of its subscales.
  
  
  RESULTS
  In the 442 patients enrolled, 25% endorsed chronic symptoms. There was a significant difference in the proportion of patients scoring positive for psychosocial impairment between the acute and chronic group (13.8% vs 18.1%, P = 0.002) as well as in the proportion of patients testing positive for attentional issues (6.4% vs 13.9%, P = 0.02). Each subscale was analyzed independently, and there were no statistically significant intergroup differences in internalizing symptoms (anxiety, depression) or externalizing symptoms (conduct issues).
  
  
  CONCLUSIONS
  Patients with recurrent presentations for the same complaint had significantly higher rates of overall psychosocial impairment. Regardless of complaint acuity, impairment rates were notable, with 20% of patients reporting internalizing symptoms, such as anxiety and depression. Psychosocial issues should be considered in all pediatric ED patients but particularly those with greater than 3 health care visits for the same presenting complaint.
authors.affiliation: Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Ilene
authors.initials: I
authors.lastname: Claudius
authors.forename: Nicole
authors.initials: N
authors.lastname: Mahrer
authors.forename: Alan L
authors.initials: AL
authors.lastname: Nager
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Gold
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000294:Adolescent Behavior; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D011581:Psychological Tests; D011584:Psychology; D000297:Psychology, Adolescent; D002666:Psychology, Child; D012008:Recurrence; D011795:Surveys and Questionnaires