45 - Suicidal Behaviors and Associations with Patient Characteristics in Children Before and During the SARS-CoV-2 Pandemic

Poster Number: 45
Publication Number: 45.103

Hannah E. Smith, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Donald H. Arnold, Vanderbilt University School of Medicine, Nashville, TN, United States; Barron Frazier, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; James C. Gay, Vanderbilt University Medical Center, Nashville, TN, United States; Emily A. Kleiman, Vanderbilt University Medical Center, Nashville, TN, United States; Elizabeth Keiner, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Amelia Wong, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Marla Levine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States

Background:
Suicide is the second leading cause of death among ages 10-24 in the United States. During the SARS-CoV-2 pandemic there has been an increase in U.S. pediatric emergency department (PED) chief complaints related to suicidal ideation (SI) or suicide attempt (SA). Identifying characteristics of these patients will inform resource allocation and interventions.

Objective:
To identify relevant characteristics of children presenting to a tertiary, urban children’s hospital ED with concern for SI or SA before and during the pandemic.

Design/Methods: Electronic medical records of children requiring psychiatric consult in the PED from March 2018 to March 2021 were reviewed. Patient data was included for analyses if there was documented concern for SI or SA. Demographics, Columbia-Suicide Severity Rating Scale (C-SSRS) scores, ED length of stay (LOS), and disposition were documented. For patients admitted to the hospital, total LOS, avoidable hospital days and barriers to discharge were recorded. Descriptive statistics were reported as means (SD), median [IQR], and proportions. The Chi-square and Wilcoxon rank-sum tests were used to examine differences in characteristics of patients presenting one year prior to and one year during the pandemic.

Results: Of 6,594 charts reviewed, 4,126 met inclusion criteria (Figure 1) and 67% had chief complaint of SI/SA, whereas 33% had another presenting complaint. Characteristics of the three-year cohort (Table 1) revealed most were female (63%). Median age was 14 years [12,16]. Months with the greatest number of visits included school months: November (10.1%) and September (10.1%). The least number of visits were summer months: June (5.3%) and July (5.4%). Average monthly visits were greatest in 2021. Among patients with C-SSRS scores, 78% screened high risk for SA. Characteristics of patients before and during the pandemic were compared (Table 2). Statistically significant differences included an increase in the proportion of females (62% to 67%) and adolescents (81% to 88%) during the pandemic. Children presenting during the pandemic were more likely to be admitted to the hospital or psychiatric facility (70% to 77%). Over the three years, the most common barrier to hospital discharge was lack of psychiatric bed availability (76%) resulting in 2,990 avoidable hospital days.Conclusion(s): Most children presenting with SI/SA to an academic, tertiary children’s hospital ED were high-risk for suicide on C-SSRS score, were adolescent white females and presented during school months. Greater availability of inpatient psychiatric care may decrease avoidable hospitalization days.
Hannah Smith Curriculum VitaeSmith, Hannah - CV 2021.pdf
Table 1: Characteristics of 4,126 Children Aged 4–19 Who Presented to an Academic PED with Concern for SI or SA between March 2018 to March 2021