Journal Article Annotations
2020, 4th Quarter
Annotations by Jeylan Close, MD
PUBLICATION #1 — Child and Adolescent Psychiatry/ Pediatrics
The authors did a chart review in a tertiary children’s hospital to identify patients with a diagnosis of somatic symptoms and related disorders (SSRD) and examined a variety of patient characteristics, as well as what was involved in their care throughout their hospital stay. Notable patient characteristics included multiple SSRD symptoms in 76%, a medical comorbidity in 65%, and psychiatric comorbidity in 46%. In looking at external factors, they found that 80% had SSRD symptoms that overlapped with a family member’s diagnosed medical illness and 75% had a precipitating emotional stressor. They found that the rates of interventions such as interdisciplinary and family meetings compared to what is recommended by the AACAP’s SSRD clinical pathway was suboptimal. Of patients with functional neurologic symptoms, 70% had a listed somatic discharge diagnosis, compared to 40% of patients with non-neurologic somatic symptoms. One in three patients were readmitted during the 18 month study period.
Strength and weaknesses:
Limitations include retrospective data collection, use of only a single site, and reliance on identifying SSRD by diagnosis in the chart. The authors could not comment on whether any noted characteristics of patients with SSRD have an impact on clinical course. Additionally, they did not develop a treatment pathway or determine if one was effective. Strengths include examining multiple aspects of the clinical picture including incidences of consults, multidisciplinary meetings, individual symptoms, and social and family history.
Consistent with the authors’ findings, SSRD is a common diagnosis of patients admitted to pediatric hospitals. SSRD is the second most common diagnosis leading to Child Psychiatry consultation. Furthering understanding of common characteristics of these patients may aid in elucidating improved methods of early identification, which could decrease burden on patients, families, and hospitals. Additionally, this paper exemplifies an approach to examining implementation of recommended clinical pathways and identifying areas for improvement to enhance quality of care.
Type of study (EBM guide):