Abstract Title: Psychiatric Care in the Pediatric Emergency Department Authors: Priyanka Kaushal, Lisa Gorham, Cedric Bruges, James Rudloff, Viani Dickey, Cynthia Rogers, & George Hoganson

Background: Due to surging demand for pediatric psychiatric services, emergency departments (EDs) are increasingly utilized by parents and community physicians to address psychiatric concerns. Further research is needed to understand the expectations of families seeking ED care for their children and barriers to community psychiatric services. We hypothesized that most families seek services in the ED due to unmet needs in the community and that there would be a mismatch of expectations between care sought and care received.

Methods: Parents of children presenting with psychiatric complaints at the St. Louis Children’s Hospital ED completed a survey about their child. We extracted patient demographics, diagnoses, length of stay (LOS), and disposition from the medical record. Our primary outcomes were parent-reported goals for treatment and barriers to care outside of the ED as well as risk factors for being admitted.

Results: We included 151 children in the final cohort (52% female, mean age 13.3 years, 66% White, 23% Black). The most common diagnoses were suicidal ideation/attempt (54.3%), depression (27.8%), ADHD (19.2%), aggression (17.9%), anxiety (11.9%), and self-harm (9.3%). Parent-reported reason(s) for ED visits included seeking overnight hospitalization (59%), medication changes (42%), a diagnosis (42%), counseling (36%), and intensive outpatient therapy (36%). Commonly reported barrier(s) to treatment outside of the ED included long wait lists for providers (36%), providers not accepting new patients (24%), and insurance issues (14%). The median LOS in the ED was 18.33 hours (range: 2.7 to 167.7 hours). Males, on average, had a longer LOS (t=-2.05, df=103, p=0.04). 28% of children got admitted, 15% were transferred to another psychiatric facility, and 57% were discharged. Of those families who sought inpatient care, only 61% were admitted/transferred. Across all subjects, having a diagnosis of depression (X2=31.99, df=1, p<0.001) and being older (OR 1.45, 95% CI 1.25-1.71, p<0.001) made children more likely to be admitted.

Conclusion: The gap between families seeking inpatient care and actual admissions underscores the need for better outpatient access. By identifying barriers to care and mismatched expectations, this study helps inform policies to better support families in need.