Substance Abuse and Mental Health Visits Among Adolescents Presenting to US Emergency Departments

Fahimi, Jahan; Aurrecoechea, Adrian; Anderson, Eric G.; Herring, Andrew A.; Alter, Harrison J.

doi:10.1097/pec.0000000000000421

Cited by 46 publications

(37 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, it is not possible to impute from the 12–17 age group to the younger children and adolescents. Females predominate in ambulance attendances for all three harms in the 12–17 age group, which is consistent with previous Australian studies looking at emergency department attendances in adolescents aged 12–18 [ 31 ] and United States studies looking at emergency department attendances in 11–24 year olds [ 32 ]. However, we found that in the 7–11 age group, males were over-represented.…”

Section: Discussionsupporting

confidence: 89%

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12–17

Scott

Crossin

Ogeil

et al. 2018

IJERPH

View full text Add to dashboard Cite

Many population data sources do not routinely collect data of children under 12, despite research showing that mental health, self-injurious behaviour, and substance ingestion can have severe consequences in this age group. We used 6 years (January 2012 to December 2017) of ambulance attendance data from the Australian state of Victoria to characterise mental health, self-injurious behaviour, and substance ingestion in children aged 7–11. We compared this group to older children aged 12–17. We found that in comparison to those aged 12–17 (n = 26,778), a smaller number of children aged 7–11 years (n = 1558) were experiencing serious harms, with mental health symptomology the most common harmful outcome. Self-injurious behaviour significantly increased in both age groups throughout the study period. For mental health, self-injurious behaviour and substance ingestion in the 7–11 age group, males were significantly over-represented. These aged 7–11 were more likely to ingest pharmaceuticals, rather than alcohol or illicit substances, and suicidal ideation was the most common self-injurious behaviour in this age group. Our study suggests that data collection needs to occur specifically in the 7–11 age group, and importantly, services and interventions to improve mental health and wellbeing will need to be specifically designed and targeted at this age group.

show abstract

Section: Discussionsupporting

confidence: 89%

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12–17

Scott

Crossin

Ogeil

et al. 2018

IJERPH

View full text Add to dashboard Cite

show abstract

“…Even though we found that the legalization for recreational use of cannabis will likely not have a significant impact on TWH's ED resource utilization, two factors should be considered when interpreting these results: (1) TWH's ED number of cannabis visits could be misrepresented since data accuracy is often an issue when analyzing health administrative data, especially in substance abuse conditions when the type of substance may not be precisely recorded [56]; (2) our single-hospital results are not representative of other locations that have a well-documented history of struggling with substance abuse and addictions [57–63] (e.g., provinces such as British Columbia and Nova Scotia or the Thunder Bay district within Ontario). Stronger impacts on ED utilization may be observed in these places.…”

Section: Discussionmentioning

confidence: 99%

Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach

Medeiros

Hahn‐Goldberg

Aleman

et al. 2019

Journal of Healthcare Engineering

View full text Add to dashboard Cite

Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.

show abstract

“…In contrast, the mid-night cohort had a higher incidence of documented alcohol abuse and positive ED toxicology results for both alcohol consumption and illicit drug use -- all of which may be in fact underreported in the ED population. The high prevalence of alcohol abuse may be attributable to the phenomenon of young adults consuming alcohol at higher frequencies and amounts than older adults (Carter et al, 2010, Hingson et al, 2009); indeed, Fahimi and colleagues found that younger adults were more likely to present to the ED for alcohol and substance abuse overnight rather than during daytime hours (Fahimi et al, 2015). The confounding effects of intoxication on the neurologic exam have been well-documented in the literature and consequently the influence of nighttime hours/circadian rhythmicity on GCS score independent of known confounders is warranted as performed.…”

Section: Discussionmentioning

confidence: 99%

Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients

Yue

Robinson

Winkler

et al. 2017

Neurobiology of Sleep and Circadian Rhythms

View full text Add to dashboard Cite

Introduction The Glasgow Coma Scale (GCS) score is the primary method of assessing consciousness after traumatic brain injury (TBI), and the clinical standard for classifying TBI severity. There is scant literature discerning the influence of circadian rhythms or emergency department (ED) arrival hour on this important clinical tool. Methods Retrospective cohort analysis of adult patients suffering blunt TBI using the National Sample Program of the National Trauma Data Bank, years 2003–2006. ED arrival GCS score was characterized by midday (10 a.m.–4 p.m.) and midnight (12 a.m.–6 a.m.) cohorts (N=24548). Proportions and standard errors are reported for descriptive data. Multivariable regressions using odds ratios (OR), mean differences ( B ), and their associated 95% confidence intervals [CI] were performed to assess associations between ED arrival hour and GCS score. Statistical significance was assessed at p<0.05. Results Patients were 42.48±0.13-years-old and 69.5% male. GCS score was 12.68±0.13 (77.2% mild, 5.2% moderate, 17.6% severe-TBI). Overall, patients were injured primarily via motor vehicle accidents (52.2%) and falls (24.2%), and 85.7% were admitted to hospital (33.5% ICU). Injury severity score did not differ between day and nighttime admissions. Nighttime admissions associated with decreased systemic comorbidities (p<0.001) and increased likelihood of alcohol abuse and drug intoxication (p<0.001). GCS score demonstrated circadian rhythmicity with peak at 12 p.m. (13.03±0.08) and nadir at 4am (12.12±0.12). Midnight patients demonstrated lower GCS (12 a.m.–6 a.m.: 12.23±0.04; 10 a.m.–4 p.m.: 12.95±0.03, p<0.001). Multivariable regression adjusted for demographic and injury factors confirmed that midnight-hours independently associated with decreased GCS ( B =−0.29 [−0.40, −0.19]). In patients who did not die in ED or go directly to surgery (N=21862), midnight-hours (multivariable OR 1.73 [1.30–2.31]) associated with increased likelihood of ICU admission; increasing GCS score (per-unit OR 0.82 [0.80–0.83]) associated with decreased odds. Notably, the interaction factor ED GCS score*ED arrival hour independently demonstrated OR 0.96 [0.94–0.98], suggesting that the influence of GCS score on ICU admission odds is less important at night than during the day. Conclusions Nighttime TBI patients present with decreased GCS scores and are admitted to ICU at higher rates, yet have fewer prior comorbidities and similar systemic injuries. The interaction between nighttime hours and decreased GCS score on ICU admissions has important implications for clinical assessment/triage.

show abstract

Substance Abuse and Mental Health Visits Among Adolescents Presenting to US Emergency Departments

Cited by 46 publications

References 26 publications

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12–17

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12–17

Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach

Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients

Contact Info

Product

Resources

About