Psychotropic Medication Use in United States Pediatric Emergency Department Visits |
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| Affiliation: | 1. Division of Pediatric Critical Care and Hospital Medicine, New York-Presbyterian/Columbia University Irving Medical Center (KA Nash), New York, NY;2. Department of Psychiatry, Columbia University, New York State Psychiatric Institute (M Olfson), New York, NY;3. Department of Emergency Medicine, Yale University School of Medicine (C Rothenberg and AK Venkatesh), New Haven, Conn;4. Division of Pediatric Cardiology; New York-Presbyterian/Columbia University Irving Medical Center (BR Anderson), New York, NY;5. Department of Psychiatry, Columbia University, New York State Psychiatric Institute (HA Pincus), New York, NY;1. Department of Human Development and Family Studies (HE Brophy-Herb, J Williams, K Mitchell, MA Horodynski), Michigan State University, East Lansing, Mich;2. Department of Human Development and Quantitative Methodology (TL Martoccio), University of Maryland, College Park, Md;3. Department of Epidemiology and Biostatistics (JM Kerver), Michigan State University, East Lansing, Mich;4. Department of Childhood Education and Family Studies (HH Choi), Missouri State University, Springfield, Mo;5. Department of Pediatrics (LA Jeanpierre, J Sturza, N Kaciroti, JC Lumeng), University of Michigan Medical School, Ann Arbor, Mich;6. Pennington Biomedical Research Center (CK Martin), Louisiana State University, Baton Rouge, La;7. Michigan State University Extension (DA Contreras), Michigan State University, East Lansing, Mich;8. Office of University Outreach and Engagement (LA Van Egeren), Michigan State University, East Lansing, Mich;9. Department of Biostatistics (N Kaciroti), University of Michigan, Ann Arbor, Mich;10. Department of Nutritional Sciences (JC Lumeng), University of Michigan School of Public Health, Ann Arbor, Mich;1. Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis;2. M Simulation (E Norbie and A Woll), University of Minnesota, Minneapolis;3. Department of Educational Psychology and Research Methodology Consulting Center (JK Bye), University of Minnesota, Minneapolis;4. Children''s Minnesota-Saint Paul (H Kamrath), Neonatology, Garden View Medical Center, Minn;1. Ward Family Heart Center, Children''s Mercy Hospital Kansas City and Division of Pediatric Cardiology (L Malloy-Walton), University of Missouri School of Medicine, Kansas City;2. Ward Family Heart Center, Children''s Mercy Hospital Wichita and Division of Pediatric Cardiology (L Gopineti), Kansas University School of Medicine, Wichita;3. Herma Heart Institute, Children''s Hospital of Wisconsin (AJ Thompson), Milwaukee;4. The Cardiac Center (VL Vetter), Children''s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia;5. The Heart Institute, Cincinnati Children''s Hospital Medical Center and Division of Pediatric Cardiology (SP Batlivala), University of Cincinnati College of Medicine, Ohio;1. Division of Emergency Medicine, Department of Pediatrics, Nationwide Children''s Hospital, The Ohio State University College of Medicine (K Das and LK Middelberg), Columbus, Ohio;2. Division of Primary Care Pediatrics, Department of Pediatrics, Nationwide Children''s Hospital, The Ohio State University College of Medicine (SA Denny), Columbus, Ohio;1. Department of Psychiatry, Massachusetts General Hospital (TS Benheim, JM Murphy, A Dutta, JM Holcomb, and MS Jellinek), Boston, Mass;2. Department of Psychiatry, Harvard Medical School (JM Murphy, DR Hirshfeld-Becker, and MS Jellinek), Boston, Mass;3. Department of Health Law, Policy & Management, Boston University School of Public Health (RC Sheldrick), Boston, Mass;4. Department of Psychology, Suffolk University (JM Holcomb), Boston, Mass;5. Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital (DR Hirshfeld-Becker, M Ver Pault and J Holmén), Boston, Mass;6. Department of Psychology, University of Massachusetts Boston (AS Carter), Boston, Mass;7. Department of Counseling Psychology, Boston College Lynch School of Education and Human Development (A Riobueno-Naylor), Chestnut Hill, Mass;8. Department of Pediatrics, Massachusetts General Hospital (AA Boudreau), Boston, Mass;9. Department of Pediatrics, Harvard Medical School (AA Boudreau and MS Jellinek), Boston, Mass;10. Department of Pediatrics, Tufts Children''s Hospital (EC Perrin), Boston, Mass |
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| Abstract: | Objective and BackgroundLittle 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.MethodsWe 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.ResultsA 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.ConclusionsA 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. |
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