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Psychotropic Medication Use in United States Pediatric Emergency Department Visits

Published:December 05, 2022DOI:https://doi.org/10.1016/j.acap.2022.11.016

      Abstract

      Objective and Background

      Little is known about pediatric psychotropic medication use in the emergency department (ED), despite a rise in mental and behavioral health visits. This study describes psychotropic medication use in a nationally representative sample of pediatric mental and behavioral health ED visits over a 14-year period.

      Methods

      We conducted a cross-sectional analysis of pediatric (6–17 years) mental and behavioral health ED visits using the National Hospital Ambulatory Medical Care Survey, 2006–2019. We describe administration of psychotropic medications by medication type, diagnosis, and over time. Using multivariable survey-weighted logistic regression, we examine associations between medication administration and sociodemographics.

      Results

      A psychotropic medication was administered in 11.4% of the estimated 11,792,860 pediatric mental and behavioral health ED visits in our sample. Benzodiazepines were administered most frequently (4.9% of visits). Visits with anxiety disorders had the highest frequency of psychotropic medication use (26.7%). Visits by Black non-Hispanic patients had a 60% decreased odds of medication administration compared to visits for White non-Hispanic patients. Visits with public compared to private insurance had a 3.5 times increased odds of psychotropic polypharmacy. The proportion of visits in which a psychotropic medication was administered did not change statistically over time.

      Conclusions

      A psychotropic medication was administered in 1 in 10 pediatric mental and behavioral health ED visits. Use differed by sociodemographics but did not change over time. As more youth seek mental and behavioral health care in the ED, we must better understand appropriate medication use to ensure quality and equitable care.

      Keywords

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      References

        • Kalb LG
        • Stapp EK
        • Ballard ED
        • et al.
        Trends in psychiatric emergency department visits among youth and young adults in the US.
        Pediatrics. 2019; e20182192
        • Lo CB
        • Bridge JA
        • Shi J
        • et al.
        Children's mental health emergency department visits: 2007–2016.
        Pediatrics. 2020; 145e20191536
        • Samji H
        • Wu J
        • Ladak A
        • et al.
        Review: mental health impacts of the COVID-19 pandemic on children and youth—a systematic review.
        Child Adolesc Ment Health. 2021; 27: 173-189
        • Leeb RT
        • Bitsko RH
        • Radhakrishnan L
        • et al.
        Mental health–related emergency department visits among children aged <18 years during the COVID-19 pandemic — United States, January 1–October 17, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1675-1680
        • Shankar LG
        • Habich M
        • Rosenman M
        • et al.
        Mental health emergency department visits by children before and during the COVID-19 pandemic.
        Acad Pediatr. 2022; 22: 1127-1132
        • Hoffmann JA
        • Pergjika A
        • Konicek CE
        • et al.
        Pharmacologic management of acute agitation in youth in the emergency department.
        Pediatr Emerg Care. 2021; 37: 417-422
        • Gerson R
        • Malas N
        • Feuer V
        • et al.
        Best practices for evaluation and treatment of agitated children and adolescents (BETA) in the emergency department: consensus statement of the American Association for Emergency Psychiatry.
        West J Emerg Med. 2019; 20: 409-418
        • Kendrick JG
        • Goldman RD
        • Carr RR.
        Pharmacologic management of agitation and aggression in a pediatric emergency department—a retrospective cohort study.
        J Pediatr Pharmacol Ther. 2018; 23: 455-459
        • Vitiello B
        • Davico C.
        Twenty years of progress in paediatric psychopharmacology: accomplishments and unmet needs.
        Evid Based Ment Health. 2018; 21: e10
        • Chirdkiatgumchai V
        • Xiao H
        • Fredstrom BK
        • et al.
        National trends in psychotropic medication use in young children: 1994-2009.
        Pediatrics. 2013; 132: 615-623
        • Comer JS
        • Olfson M
        • Mojtabai R.
        National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007.
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 1001-1010
        • Olfson M
        • Blanco C
        • Liu L
        • et al.
        National trends in the outpatient treatment of children and adolescents with antipsychotic drugs.
        Arch Gen Psychiatry. 2006; 63: 679
        • Gerson R
        • Malas N
        • Feuer V
        • et al.
        Best practices for evaluation and treatment of agitated children and adolescents (BETA) in the emergency department: consensus statement of the American Association for Emergency Psychiatry.
        West J Emerg Med. 2019; 20: 409-418
        • Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter. In: Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care
        Smedley BD Stith AY Nelson AR Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academies Press (US) Copyright 2002 by the National Academy of Sciences. All rights reserved, Washington, DC2003
        • Healthcare Disparities and
        Cultural Competency Consensus Standards: Disparities-Sensitive Measure Assessment Technical Report. National Quality Forum, Washington, DC2012
        • Foster AA
        • Porter JJ
        • Monuteaux MC
        • et al.
        Pharmacologic restraint use during mental health visits in pediatric emergency departments.
        J Pediatr. 2021; 236 (e272): 276-283
        • Whitfill T
        • Auerbach M
        • Scherzer DJ
        • et al.
        Emergency care for children in the United States: epidemiology and trends over time.
        J Emerg Med. 2018; 55: 423-434
        • Remick K
        • Gausche-Hill M
        • Joseph MM
        • et al.
        Pediatric readiness in the emergency department.
        Pediatrics. 2018; 142e20182459
        • Marrast L
        • Himmelstein DU
        • Woolhandler S.
        Racial and ethnic disparities in mental healthcare for children and young adults: a national study.
        Int J Health Serv. 2016; 46: 810-824
      1. About the Ambulatory Healthcare Surveys. The Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nchs/ahcd/about_ahcd.htm. Updated December 30, 2021. Accessed June 30, 2022.

        • Nash KA
        • Zima BT
        • Rothenberg C
        • et al.
        Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).
        Pediatrics. 2021; 147e2020030692
        • Holder SM
        • Rogers K
        • Peterson E
        • et al.
        The impact of mental health services in a pediatric emergency department: the implications of having trained psychiatric professionals.
        Pediatr Emerg Care. 2017; 33: 311-314
      2. Zima BT, Rodean J. Mental health disorder codes, child and adolescent mental health disorders classification system (CAMHD-CS). Available at: https://www.childrenshospitals.org/Research-and-Data/Pediatric-Data-and-Trends/2019/Mental-Health-Disorder-Codes. 2019. Updated 9/10/19. Accessed January 20, 2020.

        • Coker TR
        • Elliott MN
        • Toomey SL
        • et al.
        Racial and ethnic disparities in ADHD diagnosis and treatment.
        Pediatrics. 2016; 138e20160407
        • Fadus MC
        • Ginsburg KR
        • Sobowale K
        • et al.
        Unconscious bias and the diagnosis of disruptive behavior disorders and ADHD in African American and Hispanic Youth.
        Acad Psychiatry. 2020; 44: 95-102
        • Centers for Disease Control and Prevention
        Youth Risk Behavior Survey (YRBS) Data Summary and Trends 2009-2019.
        Center for Disease Control and Prevention, 2019. Atlanta, GA
      3. AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health [press release]. Advocacy, American Academy of Pediatrics. 2021. Available at: https://www.aap.org. Accessed September 1, 2022.

      4. Office of the U.S. Surgeon General. Protecting Youth Mental Health: The U.S. Surgeon General's Advisory.U.S. Department of healtlh and Human Services, Office of the U.S. Surgeon General; 2021. Available at: HHS.gov. Accessed September 1, 2022.

        • Kendrick JG
        • Goldman RD
        • Carr RR.
        Pharmacologic management of agitation and aggression in a pediatric emergency department—a retrospective cohort study.
        J Pediatr Pharmacol Ther. 2018; 23: 455-459
        • Foster AA
        • Porter JJ
        • Monuteaux MC
        • et al.
        Pharmacologic restraint use during mental health visits in pediatric emergency departments.
        J Pediatr. 2021; 236: 276-283.e2
        • Gausche-Hill M
        • Ely M
        • Schmuhl P
        • et al.
        A national assessment of pediatric readiness of emergency departments.
        JAMA Pediatr. 2015; 169: 527-534
        • Toce MS
        • Michelson KA
        • Hudgins JD
        • et al.
        Trends in benzodiazepine prescribing for US adolescents and young adults from 2008 to 2019.
        JAMA Pediatr. 2021; 176: 312-313
        • Zhang S
        • Cain DS
        • Liao M.
        Racial/ethnic disparities in the decision points of mental health service use and psychotropic medication receipt among depressed youth.
        Youth Soc. 2021; 53: 610-635
        • Rodgers CRR
        • Flores MW
        • Bassey O
        • et al.
        Racial/ethnic disparity trends in children’s mental healthcare access and expenditures from 2010 to 2017: disparities remain despite sweeping policy reform.
        J Am Acad Child Adolesc Psychiatry. 2021; 61: 915-925
        • Cummings JR
        • Ji X
        • Lally C
        • et al.
        Racial and ethnic differences in minimally adequate depression care among Medicaid-enrolled youth.
        J Am Acad Child Adolesc Psychiatry. 2019; 58: 128-138
        • Trent M
        • Dooley DG
        • Dougé J.
        The impact of racism on child and adolescent health.
        Pediatrics. 2019; 144e20191765