Emergency department pediatric mental and behavioral health patients transported by EMS and police: Trends and interventions

Alexandra Cheetham; Lynn Babcock; Victoria Hartwell; Hamilton Schwartz; Rachel Bensman; Sang Hoon Lee; Lauren Riney; Olga Semenova; Yin Zhang; Wendy J Pomerantz

doi:10.1016/j.acap.2024.05.001

Emergency department pediatric mental and behavioral health patients transported by EMS and police: Trends and interventions

Acad Pediatr. 2024 May 14:S1876-2859(24)00157-8. doi: 10.1016/j.acap.2024.05.001. Online ahead of print.

Authors

Affiliations

¹ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Alexandra.cheetham@cchmc.org.
² Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Lynn.babcock@cchmc.org.
³ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Victoria.hartwell@cchmc.org.
⁴ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Hamilton.schwartz@cchmc.org.
⁵ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Rachel.bensmas@cchmc.org.
⁶ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Sanghoon.lee@cchmc.org.
⁷ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Lauren.riney@cchmc.org.
⁸ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA. Electronic address: Olga.semenova@cchmc.org.
⁹ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA. Electronic address: Yin.zhang@cchmc.org.
¹⁰ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA. Electronic address: Wendy.pomerantz@cchmc.org.

PMID: 38754700
DOI: 10.1016/j.acap.2024.05.001

Abstract

Objective: We aimed to understand transport utilization trends, demographics, Emergency Department (ED) interventions, and outcomes of pediatric mental and behavioral health (MBH) patients transported by emergency medical services (EMS), police, or self-transported.

Methods: This retrospective cohort study utilized electronic health record data from patients aged 5-18 years presenting with acute MBH conditions at two affiliated pediatric EDs from January 2012 to December 2020. Data included demographics, ED interventions for aggression/agitation, Brief Rating of Aggression by Children and Adolescents (BRACHA) scores, and ED dispositions. Descriptive statistics and comparative analyses were conducted using Chi-square, Wilcoxon rank sum tests, and multivariable logistic regression. Linear regression analyzed trends.

Results: Of 440,302 ED encounters, 70,557 (16%) were for acute MBH concerns, with 14.6% transported by EMS and 5.9% by police. The proportion of MBH visits increased from 9.9% in 2012 to 19.8% in 2020 (95% CI [0.7, 1.7], p = 0.0009), with a concurrent 0.4% annual increase in those transported by EMS (95% CI [0.2, 0.6], p = 0.006). MBH patients transported by EMS and police had significantly higher odds of requiring restraint in the ED and were more likely to have higher BRACHA scores, and to be admitted compared to self-transported patients (all comparisons p < 0.001).

Conclusions: Pediatric MBH ED visits and EMS utilization are increasing. MBH patients transported by EMS and police may represent a more aggressive ED population. Given the rising encounters within this high-risk population, our EDs, EMS, and police need support and resources for safe pediatric MBH patient management.

What's new: With higher numbers of pediatric mental and behavioral health (MBH) patients transported by EMS or police requiring ED interventions for agitation/aggression, this study reveals insights into their high-acuity. Notably unique, it includes pediatric MBH patients transported by police.

Keywords: emergency medical services; mental health; pediatric; police; psychiatric.