Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation
Publication Date
2014
Journal Title
Eur Child Adolesc Psychiatry
Abstract
We aimed to describe the characteristics and disposition of youth referred from schools to the emergency department (ED) for psychiatric evaluations. Consecutive 12-month records of ED psychiatric consultations at a large urban hospital from 07.01.2009 to 06.30.2010 were retrospectively analyzed. School-initiated referrals were deemed inappropriate if youth were discharged from the ED without any recommended mental health follow-up. Of the 551 psychiatric ED evaluations, 243 (44.1 %) were initiated by schools. Of all school referrals, only 19 (7.8 %) children were psychiatrically hospitalized, 108 (44.4 %) were discharged from the ED with a follow-up appointment; and 116 (47.7 %) were discharged without arranged follow-up. Those with a chief complaint of "suicidality" (n = 109, 44.9 %) were more likely to be discharged without arranged follow-up than youth with other presenting complaints (56.0 vs. 41.0 %, p = 0.021). Altogether, only 37 (18.5 %) of 200 school-referred youth with information were evaluated by a school nurse, social worker, or other professional before being sent to the ED. Students without in-school screening were significantly more frequently discharged without follow-up than students with in-school evaluations prior to the ED referral (51.5 vs. 27.0 %, p = 0.0070; odds ratio = 2.87 (95 % CI 1.30-6.31). Multivariate predictors of inappropriate school referrals of youth discharged without any outpatient follow-up were higher Children's Global Assessment Scale score (p < 0.0001), absent in-school evaluation (p = 0.0069), absent prior psychiatric history (p = 0.011) and absent current psychotropic medication treatment (p = 0.012) (r 2 = 0.264 %, p < 0.0001). Altogether 44.1 % of ED consultations were school referred, of which 47.7 % were potentially inappropriate for the emergency setting. In-school screening, which occurred infrequently, reduced unnecessary evaluations by 52 %.
Volume Number
24
Issue Number
7
Pages
731-43
Document Type
Article
EPub Date
2014/09/28
Status
Faculty
Facility
School of Medicine
Primary Department
Psychiatry
Additional Departments
Molecular Medicine
PMID
DOI
10.1007/s00787-014-0618-8