606 - Characteristics Associated with High Frequency Emergency Department Use for Behavioral Health Conditions among Children

Publication Number: 1583.606

Saranya Menon, University of Illinois College of Medicine, Gurnee, IL, United States; Julia Wnorowska, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, CHICAGO, IL, United States; Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Pediatric mental health emergency department (ED) visits are increasing, particularly for suicide-related concerns. More than 1 in 10 children seen in the ED for a mental health reason return within 6 months. High frequency ED use has been defined as ≥4 annual ED visits. There are limited data describing high frequency ED use for mental health reasons among children.

Objective: To examine sociodemographic and clinical characteristics associated with high frequency ED use by children for mental health conditions.

Design/Methods: We conducted a retrospective cross-sectional study of mental health ED visits by children 3-17 years old of 43 hospitals participating in the 2023-2024 Pediatric Hospital Information Systems database. Mental health visits were defined based on a primary diagnosis code within the Childhood and Adolescent Mental Health Disorders Classification System. We evaluated factors associated with high frequency ED utilization for a mental health-related concern within 12 months using multivariable logistic regression for the overall cohort and suicide/self-injury subgroup.

Results: Among 67,908 children aged 3-17 with at least one mental health-related ED visit in 2023, 3633 (5.3%) met criteria for high frequency use (Table 1). Within the suicide/self-injury subgroup (n=37,742), 6.2% children met high‑frequency ED use criteria (Table 2). The adjusted odds of high frequency ED use were higher for Hispanic (aOR 1.19, 95% CI 1.07, 1.32) and non-Hispanic Black children (aOR 1.50, 95% CI 1.36, 1.64) compared to non-Hispanic White children, and for children with neurodevelopmental disorders (aOR 1.50, 95% CI 1.38, 1.64) (Table 3) relative to those without. The adjusted odds of high frequency ED use were lower among children with private insurance (aOR 0.58, 95% CI 0.53, 0.63) versus public insurance. The adjusted odds of high-frequency use were higher for non-Hispanic Black children (aOR 1.44, 95% CI 1.26, 1.66), for those with neurodevelopmental disorders (aOR 1.58, 95% CI 1.42, 1.77), and lower among children with private insurance (aOR 0.54, 95% CI 0.48, 0.61).

Conclusion(s): Approximately 1 in 20 children with a mental health concern in the ED met criteria for high frequency ED use. High frequency ED in these patients differed by race, ethnicity, payor status, and presence of neurodevelopmental disorders. Strategies to reduce high frequency ED use include boosting primary and mental health care access for racial groups facing structural barriers, improving access to care for children with public insurance, and increasing community supports for families of children with neurodevelopmental concerns.

Table 1 - Sociodemographic and clinical characteristics of children with mental health ED visits by frequency of ED use


Table 2 - Characteristics of children with suicide-related ED visits by frequency of ED use


Table 3 - Association of patient characteristics and high frequency ED use for children with mental health ED visits and suicide-related ED visits