Psychiatric Emergencies in Children and Adolescents: Who are the Frequent Attenders?

Abstract

Introduction: Frequent attenders to the emergency department affect quality of care and imply resource overuse. Data regarding child and adolescent psychiatric frequent attendance to the emergency department
is scarce, although their number of visits is growing. Objective: To characterize child and adolescent frequent attenders in the psychiatric emergency department of Hospital Clínic de Barcelona during the year 2017. Methods: Retrospective observational study, case-control design. We selected all minors who attended our psychiatric emergency department in 2017 that belonged to our catchment area. We collected sociodemographic and clinical data through automatic extraction and manual review of electronic medical records. Frequent attendance was established as ?5 visits/year. We performed a descriptive analysis of frequent attenders and a bivariate analysis comparing frequent attenders versus non-frequent attenders. Results: Our sample included 550 children and adolescents, of which 3.8% (n=21) were frequent attenders. There were significantly more foreigners among frequent attenders (28.6% vs 13.1%, p=0.04), without other differences between groups. Among frequent attenders, conduct disorders were the most prevalent main diagnoses (33.3%), all had at least one psychotropic medication prescribed (antipsychotics in 95.2%) and social vulnerability factors were present for most of them (family conflict in 61.8%, 48% living in residential care institutions). Conclusions: Child and adolescent frequent attendance to the psychiatric emergency department is a reality. They are a socially vulnerable and highly medicated subgroup, with a preponderance of conduct problems. They are in need of a comprehensive and multidisciplinary approach,
were social services are a key feature.