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Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation

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Abstract

We aimed to describe the characteristics and disposition of youth referred from schools to the emergency department (ED) for psychiatric evaluations. Consecutive 12-month records of ED psychiatric consultations at a large urban hospital from 07.01.2009 to 06.30.2010 were retrospectively analyzed. School-initiated referrals were deemed inappropriate if youth were discharged from the ED without any recommended mental health follow-up. Of the 551 psychiatric ED evaluations, 243 (44.1 %) were initiated by schools. Of all school referrals, only 19 (7.8 %) children were psychiatrically hospitalized, 108 (44.4 %) were discharged from the ED with a follow-up appointment; and 116 (47.7 %) were discharged without arranged follow-up. Those with a chief complaint of “suicidality” (n = 109, 44.9 %) were more likely to be discharged without arranged follow-up than youth with other presenting complaints (56.0 vs. 41.0 %, p = 0.021). Altogether, only 37 (18.5 %) of 200 school-referred youth with information were evaluated by a school nurse, social worker, or other professional before being sent to the ED. Students without in-school screening were significantly more frequently discharged without follow-up than students with in-school evaluations prior to the ED referral (51.5 vs. 27.0 %, p = 0.0070; odds ratio = 2.87 (95 % CI 1.30–6.31). Multivariate predictors of inappropriate school referrals of youth discharged without any outpatient follow-up were higher Children’s Global Assessment Scale score (p < 0.0001), absent in-school evaluation (p = 0.0069), absent prior psychiatric history (p = 0.011) and absent current psychotropic medication treatment (p = 0.012) (r 2 = 0.264 %, p < 0.0001). Altogether 44.1 % of ED consultations were school referred, of which 47.7 % were potentially inappropriate for the emergency setting. In-school screening, which occurred infrequently, reduced unnecessary evaluations by 52 %.

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Acknowledgments

The study was not funded.

Conflict of interest

Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Actelion, Alexza; Bristol-Myers Squibb, Cephalon, Eli Lilly, Genentech, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, Medavante, Medscape, Merck, Otsuka, Pfizer, ProPhase, Roche, Sunovion, Takeda, Teva, and Vanda. He has received grant support from BMS, Janssen/J&J, Novo Nordisk A/S and Otsuka. Dr. Taneli has been a consultant to Quintiles, Inc. Dr. Grudnikoff has no disclosures.

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Authors and Affiliations

  1. Department of Psychiatry, The Zucker Hillside Hospital, 75-59 263rd Street Glen Oaks, Glen Oaks, NY, 11004, USA

    Eugene Grudnikoff & Christoph U. Correll

  2. Division of Child and Adolescent Psychiatry, Department of Psychiatry, Rutgers University-NJMS, Newark, NJ, USA

    Tolga Taneli

  3. Hofstra North Shore Long Island School of Medicine, Hempstead, NY, USA

    Christoph U. Correll

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Christoph U. Correll

  5. Feinstein Institute for Medical Research, Manhasset, NY, USA

    Christoph U. Correll

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Correspondence to Eugene Grudnikoff.

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Grudnikoff, E., Taneli, T. & Correll, C.U. Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation. Eur Child Adolesc Psychiatry 24, 731–743 (2015). https://doi.org/10.1007/s00787-014-0618-8

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  • DOI: https://doi.org/10.1007/s00787-014-0618-8

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