Association between child psychiatric emergency room outcomes and dimensions of psychopathology

Thomas H McCoy Jr; Anna K Wiste; Alysa E Doyle; Amelia M Pellegrini; Roy H Perlis

doi:10.1016/j.genhosppsych.2019.04.009

Association between child psychiatric emergency room outcomes and dimensions of psychopathology

Gen Hosp Psychiatry. 2019 Jul-Aug:59:1-6. doi: 10.1016/j.genhosppsych.2019.04.009. Epub 2019 Apr 16.

Authors

Thomas H McCoy Jr¹, Anna K Wiste², Alysa E Doyle³, Amelia M Pellegrini⁴, Roy H Perlis²

Affiliations

¹ Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: thmccoy@partners.org.
² Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, USA.
³ Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
⁴ Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA.

Abstract

Objective: To determine the degree to which dimensional psychopathology predicts length of stay in an emergency department (ED) and need for hospital admission among children with psychiatric complaints.

Method: Electronic health records of children age 4-17 years who presented to the ED of a large academic medical center were analyzed using a natural language processing tool to estimate Research Domain Criteria (RDoC) symptom scores. These scores' association with length of stay and probability of admission versus discharge to home were evaluated.

Results: We identified 3061 children and adolescents who presented to the ED and were evaluated by the psychiatry service between November 2008 and March 2015. Median length of stay was 7.8 h (interquartile range 5.2-14.3 h) and 1696 (55.4%) were admitted to the hospital. Higher estimated RDoC arousal, cognitive, positive, and social domain scores were associated with increased length of stay in multiple regression models, adjusted for age, sex, race, private insurance, voluntary admission, and diagnostic categories. In similarly adjusted models, odds of hospital admission were increased by higher RDoC arousal and cognitive domain scores and decreased by higher negative domain scores.

Conclusions: A natural language processing tool to characterize dimensional psychopathology identified features associated with differential outcomes in children in the psychiatric ED, most notably symptoms reflecting arousal and cognitive function. Methodologically, this in silico approach to risk stratification should facilitate precision psychiatry in children within the emergency setting.

Keywords: Computed phenotype; Electronic health record; Emergency psychiatry; Natural language processing; Risk stratification.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child, Preschool
Electronic Health Records
Emergency Services, Psychiatric / statistics & numerical data*
Female
Humans
Length of Stay / statistics & numerical data*
Male
Mental Disorders* / epidemiology
Mental Disorders* / physiopathology
Mental Disorders* / therapy
Natural Language Processing
Outcome Assessment, Health Care / statistics & numerical data*

Grants and funding

R01 MH106577/MH/NIMH NIH HHS/United States