Pediatric emergency mental health presentations during early COVID-19: Comparing virtual and in-person presentations

Abstract

Purpose: Increased mental health (MH) needs during the COVID-19 pandemic led to the implementation of a novel pediatric Emergency Department Virtual Care (EDVC) service. Our study aimed to describe the pediatric MH patient population that used EDVC by comparing patient-specific factors of those who obtained services virtually to those seen in-person. Method: This retrospective chart review was conducted at a pediatric hospital in Eastern Ontario. Children and youth (aged 3–17) who received virtual or in-person emergency MH services from May to December 2020 were included. Patient demographics, clinical presentation details and disposition were compared between the virtual and in-person groups. Data was analyzed using descriptive statistics. Results: 1104 youth (96.1%) utilized the in-person ED for MH concerns; 45 (3.9%) used EDVC. In-person youth had a higher level of perceived risk (78.9% vs. 41.9%) and were more likely to present with concerns of depression, suicidal ideation, self-harm, or laceration (46.1% vs. 35.6%). Anxiety/situational crises or behavioural issues were more likely to present virtually. Eight patients (17.8%) were redirected to the ED from EDVC. Conclusions: Several patient-specific factors varied between youth seen in-person or virtually for MH concern. Study results can assist with the design and implementation of virtual MH care platforms.

Plain Language Summary

Study comparing children and youth who used a virtual emergency mental health (MH) care service to those that went to the emergency department during the early COVID-19 pandemic to help with the development of similar platforms in the future: Why was the study done? Isolation measures during the COVID-19 pandemic left many children and youth struggling at home with mental health concerns. Limited in-person services led to the quick expansion of virtual care (VC) models in healthcare, including the introduction of Canada’s first pediatric emergency department virtual care (EDVC) service. So far, a description of patients who used this new model for emergency MH issues has not been reported. Understanding this may help with determining who is most appropriate for a virtual emergency MH visit and guide the development of safe, and effective, future virtual MH care models. What did the researchers do? Patient charts were reviewed for all patients who received virtual or in-person emergency MH care from May to December 2020. Several characteristics were then compared, including individual patient demographics and information about their visits (presenting issue, urgency of their concern, visit outcome, etc) to identify differences between these groups. What did the researchers find? A total of 1104 in-person and 45 EDVC patients were included in the study. In-person patients were identified as higher risk and were more likely to have concerns of depression or self-harm. Youth who used the VC model were more likely to present with anxiety or behavioural issues and reported more emotional distress. Eight patients were sent from EDVC to the ED, almost all (7/8, 88%) were sent for medical tests or due to safety concerns. While most patients did not have another ED visit for emergency MH issues during this period, those that did were more likely to have first used EDVC. What do the findings mean? There are several important differences between patients who used the in-person and EDVC services that could be applied to the development of future triaging and VC models. This study also explores several important limitations to VC to consider when creating similar models in the future.