Childhood Mental Health-Related Visits and Emergency Department Pediatric Volume in the United States, 2016 to 2022.

Abstract

Pediatric mental health emergency department (ED) visits are increasing, yet differences in presentations by ED type are not well described. Our objective was to examine characteristics of pediatric mental health-related ED visits by annual pediatric ED volume. We conducted a retrospective cross-sectional study of ED visits among children 5 to 17 years with a primary mental health diagnosis, identified by International Classification of Diseases, Tenth Revision, Clinical Modification codes, using the 2016 to 2022 Nationwide Emergency Department sample. The outcome was presentation to an ED with high annual pediatric volume (≥10,000 visits). Using multivariable logistic regression modeling, we examined the association with patient- and hospital-level characteristics, reporting adjusted odds ratios and 95% confidence intervals (CIs). We identified 5,369,821 weighted mental health-related visits (4.7% low, 21.2% medium, 24.1% medium-high, and 50.1% high annual pediatric volume). The adjusted odds of presenting to a high compared with a low/medium/medium-high annual pediatric volume ED were higher among non-Hispanic Black (1.19, 95% CI 1.05, 1.35) and lower among Native American (0.54, 95% CI 0.35, 0.83) children compared with non-Hispanic White children. The adjusted odds were lower for individuals with substance-related diagnoses (0.79, 95% CI 0.71, 0.87) compared with those with suicide and self-injury. Pediatric mental health-related ED visits vary by patient characteristics and diagnoses across EDs with different annual pediatric volume categories. Findings may inform opportunities to develop and deploy ED-based interventions to improve pediatric mental health outcomes across diverse populations and settings.