title: Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance?
abstract: BACKGROUND
  Pediatric and adolescent mental health complaints are growing problems for emergency departments and inpatient facilities. We sought to investigate the relationship between weeks when school is in session (vs vacation) and presentation with concern for danger to self or others.
  
  
  METHODS
  We retrospectively studied the risk of presenting with these complaints while school is in attendance compared to the risk while on vacation over a 4-year period (2009-2012) at an academic pediatric emergency department. The week of presentation was recorded for all children making psychiatric visits related to suicidality or homicidality, and these were correlated with the public school calendar for the local school district. The incidence rate ratio (IRR) was calculated for psychiatric visits while in school status vs vacation. Similar data were collected for a diagnosis of urinary tract infection to serve as a control.
  
  
  RESULTS
  Of 3223 eligible patients (mean age, 13.8 years), 82.7% presented while in school, although the students only spent 68.6% of their time in school, yielding an IRR of 2.18. By comparison, the IRR for the diagnosis of urinary tract infection was 1.25.
  
  
  CONCLUSIONS
  Children and adolescents are more likely to present with concerns for danger to self or others while attending school compared with while on vacations. Causation and opportunities for intervention require further study.
authors: University of Southern California, Keck School of Medicine, Medical School, University of Southern California, Health Sciences Campus, Los Angeles, CA, 90089.
authors: Collin
authors: C
authors: Lueck
authors: University of Southern California, Keck School of Medicine, Department of Emergency Medicine, 1200 North State St #1011, Los Angeles, CA, 90033.
authors: Liza
authors: L
authors: Kearl
authors: University of Southern California, Keck School of Medicine, Department of Emergency Medicine, 1200 North State St #1011, Los Angeles, CA, 90033.
authors: Chun Nok
authors: CN
authors: Lam
authors: University of Southern California, Keck School of Medicine, Department of Emergency Medicine, 1200 North State St #1011, Los Angeles, CA, 90033. Electronic address: iaclaudius@gmail.com.
authors: Ilene
authors: I
authors: Claudius
mesh_terms: D000293:Adolescent; D058445:Bullying / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D012189:Retrospective Studies; D012574:Schools; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D012934:Social Isolation / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology; D013995:Time