Background An alarming number of increasingly younger children are presenting to the emergency department (ED) for psychiatric crises. This investigation examines the characteristics of this cohort, ED management, and psychiatric disposition and treatment.
Method After IRB approval, a retrospective chart review was conducted on a cross-section of all patients 8-12 years old presenting to the ED in 2004. A standardized chart review form was used to extract data, which were then entered into an Access database for analysis.
Results A total of 66 charts were reviewed (68% male). Racial distribution was 56% Caucasion, 38% African American, and 6% other. Thirty-five percent had a history of abuse; 44% had an established psychiatric diagnosis before ED presentation; 62% were already on a psychiatric medication; and 38% had already been admitted to an inpatient psychiatric facility. Out of 66 patients 7 performed an act of violence at school or took a weapon to school with the intent of harming a teacher or other student. Fifty-three percent had a significant psychiatric family history. Many of these patients (64%) had multiple chief complaints; 33 were suicidal, 5 were homicidal, 39 exhibited aggression, 22 had signs of clinical depression, 8 had psychotic features, and 3 had evidence of anxiety disorder. No patients required chemical restraint in the ED. Eighty-nine percent required admission (n = 59); 52 were admitted to our institution, with 7 transferred elsewhere because of lack of beds. Average length of stay was 11 days with a range of 1-25 days.
Of the 58 patients discharged from our institution 57 had psychiatric follow-up arranged. Fifteen percent returned for a repeat psychiatric evaluation between their discharge date in 2004 and July 31, 2005.
Conclusions A significant number of 8-12 year olds have serious psychiatric illnesses. Of those that reach the ED a large number require admission. Possible risk factors indicated by this study are a family history of psychiatric illness and a personal history of sexual or physical abuse. This study also reveals the potential danger for schools from students as young as those in the third grade. This emphasizes the importance of early identification and treatment of psychiatric illness in this population.
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