Resident Physician UH Rainbow Babies & Children's Hospital Middleburg Heights, Ohio, United States
Background: During the COVID-19 pandemic, many states imposed strict lock downs limiting social interactions for children. Additionally, many children with preexisting psychiatric conditions did not receive adequate psychiatric care. Recent studies have observed a decrease in the number of psychiatric and behavioral admissions early in the pandemic. There is limited research showing the trend of these admissions later in the pandemic. Objective: To compare the rates and severity of psychiatric and behavioral admissions to tertiary care center’s inpatient units using data before (March 1st 2019 – February 29th 2020) and after (March 1st 2020 - November 29th 2021) the pandemic. Design/Methods: This was a retrospective review of pediatric patients, 5 – 18 years of age, who presented to a tertiary care center’s emergency department between March 1st 2019 and November 29th 2021 with a primary diagnosis of psychiatric or behavioral concerns. Patients with complex medical needs and those undergoing treatment for any medical condition not directly related to the presenting concern were excluded. Variables included age, sex, gender, sexual identity, race, insurance type, admission type (psychiatric or behavioral), admission severity (ED only, inpatient, ICU), school attendance, extracurricular participation, readmission and long-term harm. Pearson Chi-Square test was used for statistical analyses. Results: 341 patients were included; 158 pre-pandemic and 183 post-pandemic. Baseline characteristics were similar across groups, including median age (15 years), sex (62% female), gender identity (4% other than cisgender), sexual identity (18% other than heterosexual) and insurance type (65% public). Between groups, no significant difference was found among admission types (87% psychiatric), admission severity (52% ED only) or average length of stay (3.6 days). The post-pandemic group had a higher percentage of children with no school (19%) or with virtual attendance (42%). No statistically significant difference was found between groups for participation in extracurricular activities, readmissions or long-term harm. The number of psychiatric and behavioral admissions per month was reduced early in the pandemic and briefly returned to pre-pandemic levels between August and December 2020.
Conclusion(s): The trends in psychiatric and behavioral admissions observed in this study redemonstrates a decrease in the number of children seeking care early in the pandemic. Psychiatric and behavioral admissions later in the pandemic increased to pre-pandemic levels, however no significant change in the severity of admissions was observed.
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