title: Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program.
abstract: OBJECTIVE
  Despite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits.
  
  
  METHODS
  We examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression.
  
  
  RESULTS
  A total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances.
  
  
  CONCLUSIONS
  Repeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.
authors: *Mental Health Patient Service Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: P
authors: P
authors: Cloutier
authors: †Mental Health Research Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: N
authors: N
authors: Thibedeau
authors: ‡Clinical Research Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: N
authors: N
authors: Barrowman
authors: *Mental Health Patient Service Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: C
authors: C
authors: Gray
authors: *Mental Health Patient Service Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: A
authors: A
authors: Kennedy
authors: †Mental Health Research Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: S L
authors: SL
authors: Leon
authors: †Mental Health Research Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: C
authors: C
authors: Polihronis
authors: *Mental Health Patient Service Unit,Children's Hospital of Eastern Ontario (CHEO) Research Institute,Ottawa, ON.
authors: M
authors: M
authors: Cappelli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003419:Crisis Intervention; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D009864:Ontario
keywords: Pediatric Emergency Department; frequent visits; mental health; recent visits; repeat visitors; repeat visits