520 - Emergency Department Utilization for Mental Health During the COVID-19 Pandemic

Poster Number: 520
Publication Number: 520.422

Rajesh Sood, Inova Children's Hospital, Suitland, MD, United States; Vivian Hwang, Inova Children's Hospital, Clifton, VA, United States; Rick C. place, Rick Place, Bethesda, MD, United States; Michael J. Sheridan, Inova Health System, Inova Fairfax Medical campus, Baltimore, MD, United States

Background: Emergency department (ED) visits for mental health (MH) concerns have increased over the past decade. While a sharp decrease was noted in overall ED volume at the start of the COVID-19 pandemic, the prevalence of visits for MH concerns was significantly higher compared to previous years.

Objective: The objectives of this study were to assess the proportion and acuity of MH visits in the ED for patients aged 5-21 during the initial months of the COVID-19 pandemic compared to the previous three years.

Design/Methods: A retrospective, cohort study was conducted in a suburban ED with 130,000 annual visits (2019) that includes a dedicated pediatric ED. Data was retrieved from the hospital’s electronic medical records searching for MH chief complaints. Proportion of MH visits during the COVID-19 pandemic year (Y4: March 1, 2020- February 28, 2021) was compared to the previous three rolling years (Y1: 2017-18; Y2: 2018-19; Y3: 2019-20). Patients with substance abuse/intoxication were excluded. High acuity was defined as patients presenting after intentional ingestion of a substance, direct physical harm requiring medical hospitalization, or presenting under an emergency/temporary custody order. Acuity was assessed through random sampling of each cohort. Outcomes were stratified by age: 5-13, 14-17, 18-21. Chi-square methods (including exact tests) were used to evaluate all frequency measures. All analyses were conducted using SAS software (v9.4, SAS Institute).

Results: During Y4, 1677 patients aged 5-21 with a MH chief complaint were identified, of whom 1505 patients met inclusion criteria. The proportion of ED visits for mental health concerns was 8.8%, compared with 4.25%, 5.07%, and 5.43% for Y1-Y3, respectively (p < 0.0001). The median age was 16 years, 74.3% were female, and 33.3% presented with high acuity. There were no statistically significant differences in overall acuity when compared to prior years. However, for the cohort aged 14-17 years, the proportion presenting with high acuity increased from Y1 to Y4 with a clinically significant increase from Y3 (14.1%) to Y4 (18.7%). Conclusion(s): The proportion of MH encounters to the ED increased significantly during the pandemic year. Additionally, we saw a clinically significant increase in patients aged 14-17 presenting with high acuity.
Proportion of MH visits Y1-Y4
Acuity Stratified by age Y1-Y4