This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) examines the characteristics of patients with the highest propensity for repeat visits to a pediatric emergency department (PED).1 The literature suggests that around a quarter of all mental health services are used by repeat users. Given that that PED and in particular specialized mental health (MH) resources are limited, understanding the epidemiology identifying possible predictive characteristics of repeat users may help to improve resource allocation.
To address this group, Cloutier et al. prospectively recruited MH presentations to a specialized crisis intervention program at a single PED from October 2006 to December 2011. Data was collected into a clinical database, and patient demographics were collected. Additionally, the Child and Adolescent Needs and Strength-Mental Health tool (CANS-MH 3.0) was used as a method for the crisis intervention workers to determine if patient characteristics were “actionable” traits. Out of 4080 presentations, repeat visits were accounted for by almost half of all presentations (45.8%). Multivariable analysis identified five variables that independently predicted greater odds of repeat presentations, greater risk of earlier repeats, and greater risk of frequent repeat presentations. The five variables included female gender, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances.
Overall, repeat visits account for a large portion of MH presentations to the PED. This study identifies characteristics that increase the odds of repeat visit, and potential areas for focused intervention.