title: Trends in pediatric visits to the emergency department for psychiatric illnesses.
abstract: OBJECTIVE
  While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics.
  
  
  METHODS
  This was a retrospective, cross-sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors.
  
  
  RESULTS
  From 2001 to 2010, an average of 28.3 million pediatric visits to EDs occurred annually. Among those, an approximately 560,000 (2% of ED visits) were psychiatric visits each year. Pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010 (p = 0.01). Teenagers (adjusted odds ratio [AOR] = 3.92, 95% confidence interval [CI] = 3.37 to 4.57) and publicly insured patient visits (AOR = 1.47, 95% CI = 1.25 to 1.74) had increased odds of psychiatric ED visits.
  
  
  CONCLUSIONS
  Pediatric ED psychiatric visits are increasing. Teenagers and children with public insurance appear to be at increased risk. Further investigation is needed to determine what the causative factors are.
authors.affiliation: From the Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Zachary E
authors.initials: ZE
authors.lastname: Pittsenbarger
authors.forename: Rebekah
authors.initials: R
authors.lastname: Mannix
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology