title: Family Report Compared to Clinician-Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children.
abstract: BACKGROUND
  Psychiatric comorbidity is common in pediatric medical and surgical hospitalizations and is associated with worse hospital outcomes. Integrating medical or surgical and psychiatric hospital care depends on accurate estimates of which hospitalized children have psychiatric comorbidity.
  
  
  OBJECTIVE
  We conducted a study to determine agreement of family report (FR) and clinician documentation (CD) identification of psychiatric diagnoses in hospitalized children.
  
  
  METHODS
  This was a cross-sectional study at a tertiary-care children's hospital.
  
  
  METHODS
  The patients were children and adolescents (age, 4-21 years) who were hospitalized for medical or surgical indications.
  
  
  METHODS
  Psychiatric diagnoses were identified from structured interviews (FR) and from inpatient notes and International Classification of Diseases codes in medical records (CD). We compared estimates of point prevalence of any comorbid psychiatric diagnosis using each method, and estimated FR--CD agreement in identifying psychiatric comorbidity in hospitalized children.
  
  
  RESULTS
  Of 119 study patients, 26 (22%; 95% confidence interval [CI], 14%-29%) had a psychiatric comorbidity identified by FR, 30 (25%; 95% CI, 17%-34%) had it identified by CD, and 37 (23%-40%) had it identified by FR or CD. Agreement between FR and CD was low overall (κ = .46; 95% CI, .27-.66), highest for attention-deficit/hyperactivity disorder (κ = .78; 95% CI, .59-.97), and lowest for anxiety disorders (κ = .11; 95% CI, -.16 to .56).
  
  
  CONCLUSIONS
  Current methods may underestimate the prevalence of psychiatric conditions in hospitalized children. Information from multiple sources may be needed to develop accurate estimates of the scope of the population in need of services so that mental health resources can be appropriately allocated. Journal of Hospital Medicine 2017;12.
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, PA, USA.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Doupnik
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, Department of Internal Medicine, Institute for Healthcare Policy and Innovation, Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA.|School of Social Policy and Practice: Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus