Journal Article Annotations
2021, 1st Quarter
Annotations by Jeylan Close, MD
PUBLICATION #1 — Child and Adolescent Psychiatry/Pediatrics
A Child and Adolescent Psychiatry Consult Liaison team within a tertiary care academic pediatric hospital collected data for 5 consecutive years on all the inpatient and emergency department consults they received. They characterized consults by DSM-5 diagnosis and presenting complaint, such as suicide attempt. Additionally, they mapped the number of consults both cumulatively over time and by average per month. In total, there were 2,367 patients included in their analysis, about a third of which presented after a suicide attempt. From Jan 2015 to Dec 2019, annual inpatient consultations increased 28%, and ED consultations increased 88%. In contrast, total pediatric ED presentations increased only 8%, and medical inpatient volume slightly decreased. Suicide attempts were most prevalent in the spring of each year, from February to May (p=.03). Psychiatry consultations were most frequent each year in the months of January, April, May, October, and November (p = .001). Based on the data, they created a correlative multivariable model in hopes of predicting future consultation volume. The authors found that suicidality and a depressive diagnosis accounted for most of the seasonal variability, with no seasonal variation in other diagnoses or presenting complaint.
Strength and weaknesses:
Although there have been similar demonstrations in the literature of seasonal increases in suicidality in the spring, this study’s generalizability is limited by having been performed at a single site. Other limitations include being a retrospective analysis and using data from clinical encounters that were not formally structured, without use of standardized diagnostic scales. Strengths of the study include the large number of patients and use of 5 years of longitudinal data. The authors note that analysis of seasonal variations in presentations have not before been detailed with both DSM diagnoses and presenting complaint, and it is a strength to include more detailed data.
The author’s development of a predictive model demonstrates that it is possible to use trends in C-L consultations both cumulatively over time as well as by month to aid hospital teams with planning for staffing. Additionally, the authors noted seasonal increases in the number of patients boarding in the hospital, awaiting an inpatient psychiatric bed, which could be helpful for hospital systems’ planning. Understanding seasonal variations in diagnoses and presenting complaint can aid in creating targeted and timely preventive measures.
Type of Study:
(EBM guide): Case series or report