Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study

Bahji, Anees; Altomare, Josephine; Sapru, Anil; Haze, Spencer; Prasad, Samir; Egan, Rylan

doi:10.1016/j.psychres.2020.113149

Cited by 8 publications

(24 citation statements)

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“…For most social determinants, the effects in our study attenuated after adjustment for clinical factors. In some non-perinatal populations, younger and lower-income individuals are less Epidemiology and Psychiatric Sciences frequently admitted to hospital from the ED, even after adjusting for other factors, but there are no comparable data in postpartum populations (Unick et al, 2011;Bahji et al, 2020). Our finding that those of Chinese ethnicity had an increased likelihood of admission from the ED after accounting for clinical severity is consistent with an American study that found an increased adjusted odds of admission among Asian individuals, although that study did not differentiate between various East and South Asian ethnicities (Unick et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Hospital admission at the time of a postpartum psychiatric emergency department visit: the influence of the social determinants of health

Barker

Bronskill

Brown

et al. 2021

Epidemiol Psychiatr Sci

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Aims Social determinants of health have the potential to influence mental health and addictions-related emergency department (ED) visits and the likelihood of admission to hospital. We aimed to determine how social determinants of health, individually and in combination, relate to the likelihood of hospital admission at the time of postpartum psychiatric ED visits. Methods Among 10 702 postpartum individuals (female based on health card) presenting to the ED for a psychiatric reason in Ontario, Canada (2008–2017), we evaluated the relation between six social determinants of health (age, neighbourhood quintile [Q, Q1 = lowest, Q5 = highest], rurality, immigrant category, Chinese or South Asian ethnicity and neighbourhood ethnic diversity) and the likelihood of hospital admission from the ED. Poisson regression models generated relative risks (RR, 95% CI) of admission for each social determinant, crude and adjusted for clinical severity (diagnosis and acuity) and other potential confounders. Generalised estimating equations were used to explore additive interaction to understand whether the likelihood of admission depended on intersections of social determinants of health. Results In total, 16.0% (n = 1715) were admitted to hospital from the ED. Being young (age 19 or less v. 40 or more: RR 0.60, 95% CI 0.45–0.82), rural-dwelling (v. urban-dwelling: RR 0.75, 95% CI 0.62–0.91) and low-income (Q1 v. Q5: RR 0.81, 95% CI 0.66–0.98) were each associated with a lower likelihood of admission. Being an immigrant (non-refugee immigrant v. Canadian-born/long-term resident: RR 1.29, 95% CI 1.06–1.56), of Chinese ethnicity (v. non-Chinese/South Asian ethnicity: RR 1.88, 95% CI 1.42–2.49); and living in the most v. least ethnically diverse neighbourhoods (RR 1.24, 95% CI 1.01–1.53) were associated with a higher likelihood of admission. Only Chinese ethnicity remained significant in the fully-adjusted model (aRR 1.49, 95% CI 1.24–1.80). Additive interactions were non-significant. Conclusions For the most part, whether a postpartum ED visit resulted in admission from the ED depended primarily on the clinical severity of presentation, not on individual or intersecting social determinants of health. Being of Chinese ethnicity did increase the likelihood of admission independent of clinical severity and other measured factors; the reasons for this warrant further exploration.

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Section: Discussionmentioning

confidence: 99%

Hospital admission at the time of a postpartum psychiatric emergency department visit: the influence of the social determinants of health

Barker

Bronskill

Brown

et al. 2021

Epidemiol Psychiatr Sci

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“…To date, there are only unspeci c criteria under which conditions emergency psychiatric patients should be admitted as inpatients, in part because the aims and methods of individual studies have been inconsistent (11,12,7,(13)(14)(15)(16)). However, despite differences in study designs and country-speci c differences in health care systems, some predictors are described repeatedly.…”

Section: Introductionmentioning

confidence: 99%

“…However, despite differences in study designs and country-speci c differences in health care systems, some predictors are described repeatedly. These include the presence of suicidality and a diagnosis of schizophrenia (11,12,(17)(18)(19)(20), as well as the presence of aggressiveness, impulsivity, and danger to others (14,21,16,20). In contrast, diagnoses such as anxiety panic disorder are more likely not to result in inpatient admission (7).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, diagnoses such as anxiety panic disorder are more likely not to result in inpatient admission (7). The particular mode of transport of the patient to the ED (via ambulance and/or police) also appears to have an impact on the likelihood of admission (22,7,13,11). In addition to these factors, age and referral by a general practitioner are also reported as additional predictors (11,15,14,19,23,24).…”

Section: Introductionmentioning

confidence: 99%

“…The particular mode of transport of the patient to the ED (via ambulance and/or police) also appears to have an impact on the likelihood of admission (22,7,13,11). In addition to these factors, age and referral by a general practitioner are also reported as additional predictors (11,15,14,19,23,24). Considering that previous studies on the factors associated with the admittance of emergency psychiatric patients to hospitals have been inconsistent, the purpose of the present secondary data analysis was to add to the existing body of research by examining how recent data from a large German hospital compares to previous investigations.…”

Section: Introductionmentioning

confidence: 99%

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“Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department – results of a regression analysis.”

Kirchner

Schäfer

Ullrich

et al. 2022

Preprint

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BackgroundPsychiatric emergency patients have great relevance in the interdisciplinary emergency department. Emergency physicians in this setting often have to make decisions under time pressure based on incomplete information regarding the patient's further treatment. The aim of this study was to identify possible predictors associated with an increased likelihood of inpatient psychiatric admission, thereby facilitating future decision-making processes for clinicians regarding further treatment.MethodsA retrospective cross-sectional study of all psychiatric emergency contacts in an interdisciplinary emergency department (ED) of a general hospital in a large German city was conducted for 2015. A binary regression analysis was performed to identify possible predictors.ResultsFactors associated with an increased probability of inpatient psychiatric admission were previously known patients, patients under a legal care order (guardianship), and previous outpatient medical contact. No association for gender or age was found. Data demonstrated a negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission.ConclusionsThe conducted study showed some significant characteristics associated with an increase likelihood of emergency admission. Particularly noteworthy is the negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission. To improve the treatment of patients in emergency units, these factors should be taken into account. Further studies should be undertaken in order to develop specific emergency admission algorithms comparable to internal medicine.

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Special Population: Adults with Severe and Persistent Mental Health Disorders

Barnhouse

Clark

Davis

2023

Chronic Illness Care

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Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study

Cited by 8 publications

References 50 publications

Hospital admission at the time of a postpartum psychiatric emergency department visit: the influence of the social determinants of health

Hospital admission at the time of a postpartum psychiatric emergency department visit: the influence of the social determinants of health

“Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department – results of a regression analysis.”

Special Population: Adults with Severe and Persistent Mental Health Disorders

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