611 - Adolescent Psychosocial Screening in the Pediatric Emergency Department

Publication Number: 1588.611

Veronica Juan, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Victoria S.. Gregg, Dell Medical School, UT Austin, Austin, TX, United States; Matthew Wilkinson, University of Texas at Austin Dell Medical School, Austin, TX, United States; Sheryl Yanger, University of Texas at Austin Dell Medical School, Austin, TX, United States

Background: Adolescents are a highly vulnerable population at risk for mental health disorders and substance use, for many of whom the emergency department (ED) may be the only source of care. The American Academy of Pediatrics (AAP) recommends universal mental health screening for patients starting at 12 years of age. A psychosocial history is important in the evaluation of adolescent patients, but prior studies have shown low rates of administration and documentation in pediatric EDs.

Objective: Our objective was to determine the frequency of psychosocial screening and documentation in adolescent patients in the pediatric ED, as well as patient and provider characteristics associated with screening.

Design/Methods: This was a retrospective cohort study of a random sample of 1000 patients presenting to a large, urban, quaternary pediatric ED over a 1-year period. All patients aged 12 to 18 years were screened for inclusion, while critically ill, non-verbal or developmentally delayed patients were excluded. We performed a manual chart review to look for the following variables: documentation of any element of the HEADSS exam (Home, Employment/Education, Activities, Drugs/Alcohol, Sexual Activity, Suicidal Ideation/Depression), gender of the supervising physician, patient demographics, chief complaint, and disposition. The primary endpoint was documentation of any portion of the HEADSS exam. Descriptive statistics were used to characterize the sample. T-test, Chi-square and Fisher’s exact tests were used to analyze associations between predictor variables and HEADSS documentation.

Results: A total of 937 patients met inclusion criteria, 52.6% of which were female (Table 1). 49.9% of charts had at least one element of the HEADSS exam, the most frequent being Home (26.9%) (Table 2). Male patients were significantly less likely to undergo a HEADSS assessment compared with female patients, 42.5% vs 55.9% (p < 0.001), however, provider gender did not influence screening practices. While language did not show a significant difference, Hispanic patients were less likely to be screened than non-Hispanic. Not surprisingly, the presenting complaint influenced the likelihood of HEADSS assessment, with mental health visits being the most likely (90.2%, p< 0.001)(Table 3).

Conclusion(s): Despite expert recommendations, there continue to be gaps in psychosocial assessment of adolescent patients in the pediatric ED. Our study identified inconsistent screening based on patients’ gender, ethnicity and chief complaints implying provider bias. This data will be used to inform future quality improvement and educational interventions.

Table 1: Patient Demographics
Table 1.jpeg

Table 2: Psychosocial Documentation and Patient Encounter Characteristics
Table 2.jpeg

Table 3: Patient and Provider Characteristics and their association with Adolescent HEADSS Screening
Table 3.jpeg