521 - Impact of COVID-19 on Pediatric Mental and Behavioral Health Visits to the Emergency Department

Poster Number: 521
Publication Number: 521.422

Jacqueline Bolt, University of Texas Southwestern Medical Center/Children's Medical Center Dallas, Dallas, TX, United States; FAISALMOHEMED N. PATEL, Children's Health, FRISCO, TX, United States; Laura A. Stone, Children's Health & UT Southwestern, Dallas, TX, United States; Divya Pandian, Children's Health, McKinney, TX, United States; Nakia N. Gaines, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: The COVID-19 pandemic has been a rapidly evolving, yet unprecedentedly persistent reality for millions of Americans. As children are not immune to the social and emotional influences of the pandemic, research is needed to understand its effects on pediatric mental health and associated changes in presentations for emergency mental and behavioral health (MBH) care.

Objective: To describe changes in pediatric emergency department (ED) visits for MBH concerns before and during the early COVID-19 pandemic.

Design/Methods: We retrospectively reviewed the medical records for patients aged 5-17 years presenting to the two pediatric emergency departments of our institution, a tertiary care center averaging over 170,000 ED visits annually prior to COVID-19, with MBH-related concerns between March and September of 2017-2020. We evaluated trends in MBH ED visits over time. Additionally, patient demographics, diagnoses, disposition, and first-time presentation for a MBH concern were compared between 2019 and 2020 using Chi-square and odds ratio for bivariate analysis.

Results: Between 2017 and 2019, MBH visits increased from 3.8% to 5.3% of total pediatric ED visits. This proportion further increased to 7.5% between 2019 and 2020, reflecting a 43% increase (OR 1.46, p < 0.001). The proportion of MBH visits for older teenagers increased by 18.2% (p < 0.001), and those for females increased by 10.6% (p < 0.001). The proportion of visits resulting in admission for medical care or transfer to a psychiatric facility increased by 36.1% (p=0.009) and 51.9% (p < 0.001), respectively. The proportion of visit diagnoses related to substance use increased by 42.5% (p=0.011), and the proportion of those related to suicide and self-injury increased by 13.5% (p=0.004).Conclusion(s): The proportion of ED visits by children with MBH concerns increased during the early COVID-19 pandemic, particularly in older adolescents and females. There was an increase in substance-related diagnoses, as well as in the proportion of suicide and self-injury diagnoses. A significantly higher proportion of patients were admitted for medical care or transferred to a psychiatric facility. Health care professionals, parents, and public health officials should be aware of the increased risk for this population during the ongoing pandemic, as well as for future epidemics or catastrophic events. Further research on developing intervention strategies is needed.
Jacqueline Bolt CVJBolt CV.pdf
Table 2. ED Visit Characteristics1. Other includes AMA (left Against Medical Advice), LWBS (Left Without Being Seen), eloped, adult referral diverted elsewhere