Care in the pediatric emergency department observation unit for patients with mental health pathology before and during the SARS-CoV-2 pandemic

Abstract

Introduction: Acute psychiatric pathology in children has increased, especially during the SARS-CoV-2 pandemic. This study compared the use of the pediatric emergency observation unit for psychiatric pathology before and during the pandemic, excluding the lockdown period in Spain (March–June 2020). Materials and Methods: A retrospective observational study was conducted with patients aged 5 to 17 years who visited the emergency department (ED) in the 18 months prior to and the 18 months following the lockdown, were attended by psychiatry, and required observation. Demographic, clinical, and hospital data were analyzed, comparing both periods. Results: A total of 1,027 episodes were recorded: 279 before the pandemic and 748 during. The median age was 15.27 years, with 85.98% being female. The frequency of consultations for eating disorders increased from 20% to 31.6% (p < 0.001), and consultations for suicidal ideation increased from 16% to 23.5% (p < 0.001). Suicide attempts per 1,000 visits increased from 0.53 to 1.19 (p < 0.001), and the need for observation in the ED rose from 2.8 to 9.2 per 1,000 visits (p < 0.001). The average observation stay duration increased from 8.8 to 12 hours (p < 0.001), and bed occupancy rose from 1.95% to 7.11% (p < 0.001). Psychiatric admissions increased from 1.66 to 5.20 per 1,000 patients (p < 0.001), and overnight stays in observation increased from 41.2% to 50.2% (p < 0.001). Conclusions: During the pandemic, there was an increase in bed occupancy and observation stay times in the ED for psychiatric pathology, primarily due to eating disorders and self-harming behavior.