Emergency department visits and boarding for pediatric patients with suicidality before and during the COVID-19 pandemic

• Published in: PloS one Vol. 18; no. 11; p. e0286035
• Main Authors: Zipursky, Amy R, Olson, Karen L, Bode, Louisa, Geva, Alon, Jones, James, Mandl, Kenneth D, McMurry, Andrew
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-11-2023; Public Library of Science (PLoS)
• Subjects: Care and treatment; Child; Children; Comparative analysis; COVID-19; COVID-19 - epidemiology; Demographic aspects; Electronic health records; Emergency medical care; Emergency medical services; Emergency service; Emergency Service, Hospital; Epidemics; Ethnicity; Health aspects; Health care facilities; Hispanic Americans; Hospitals; Humans; Medical care; Medical centers; Medical colleges; Medicine and Health Sciences; Mental disorders; Mental health; Pandemics; Patients; Pediatrics; Physician and patient; Prevention; Psychiatric services; Psychiatry; Psychological aspects; Quality management; Retrospective Studies; Seasonal variations; Self destructive behavior; Suicidal behavior; Suicide; Suicides & suicide attempts; Teenagers; Variance analysis; Youth; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0286035

To quantify the increase in pediatric patients presenting to the emergency department with suicidality before and during the COVID-19 pandemic, and the subsequent impact on emergency department length of stay and boarding.
This retrospective cohort study from June 1, 2016, to October 31, 2022, identified patients ages 6 to 21 presenting to the emergency department at a pediatric academic medical center with suicidality using ICD-10 codes. Number of emergency department encounters for suicidality, demographic characteristics of patients with suicidality, and emergency department length of stay were compared before and during the COVID-19 pandemic. Unobserved components models were used to describe monthly counts of emergency department encounters for suicidality.
There were 179,736 patient encounters to the emergency department during the study period, 6,215 (3.5%) for suicidality. There were, on average, more encounters for suicidality each month during the COVID-19 pandemic than before the COVID-19 pandemic. A time series unobserved components model demonstrated a temporary drop of 32.7 encounters for suicidality in April and May of 2020 (p<0.001), followed by a sustained increase of 31.2 encounters starting in July 2020 (p = 0.003). The average length of stay for patients that boarded in the emergency department with a diagnosis of suicidality was 37.4 hours longer during the COVID-19 pandemic compared to before the COVID-19 pandemic (p<0.001).
The number of encounters for suicidality among pediatric patients and the emergency department length of stay for psychiatry boarders has increased during the COVID-19 pandemic. There is a need for acute care mental health services and solutions to emergency department capacity issues.