The Incidence of Catatonia Diagnosis Among Pediatric Patients Discharged From General Hospitals in the United States: A Kids' Inpatient Database Study

Abstract

ObjectiveCatatonia is a neuropsychiatric condition occurring across the age spectrum and associated with great morbidity and mortality. While prospective cohorts have investigated catatonia incidence among psychiatric patients, no studies have comprehensively explored the incidence of catatonia in general hospitals. We examine the incidence of catatonia diagnosis, demographics of catatonia patients, comorbidities, and inpatient procedures utilized among pediatric patients hospitalized with catatonia in the United States.MethodsThe Kids' Inpatient Database, a national all-payors sample of pediatric hospitalizations in general hospitals, was examined for the year 2019. Hospitalizations with a discharge diagnosis of catatonia were included in the analysis. Hospitalizations with catatonia as the primary discharge diagnosis were compared to hospitalizations with catatonia as a secondary discharge diagnosis.ResultsA total of 900 (95% CI: 850–949) pediatric discharges (291 with catatonia as a primary diagnosis, 609 with catatonia as a secondary diagnosis) occurred during the study year. Mean age was 15.6 ± 2.6 years, and 9.9% were under age 13. Comorbidities were common among patients with catatonia, with psychotic disorders (165; 18.3%), major depressive disorder (69; 7.7%), bipolar disorder (39; 4.3%) and substance-related disorders (20; 2.2%) as the most common primary diagnoses. There was significant comorbidity with neurologic illness, developmental disorders, autism spectrum disorder, and inflammatory conditions. In total 390 catatonia discharges (43.3%) included at least one procedure during admission.Conclusionscatatonia is rarely diagnosed in pediatric patients in general hospitals but is associated with significant and severe psychiatric and medical comorbidities. Further research is needed into the optimal diagnosis, workup, and treatment of catatonia in pediatric patients.

Co-Occurring Catatonia and COVID-19 Diagnoses Among Hospitalized Individuals in 2020: A National Inpatient Sample Analysis

“…Consistent with data from the 2019 NIS, 14 , 15 catatonia was rarely diagnosed in 2020, with a catatonia code included in a total of 0.05% of the 32,355,827 hospitalizations in the 2020 NIS. Among the total 16,575 catatonia cases, 610 (3.7%) involved a co-occurring diagnosis of COVID-19.…”

Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia

“…Historically, catatonia has been well-defined in adults with schizophrenia, affective disorders, and medical illness 12 . Recent reports, however, suggest the prevalence of catatonia in outpatient pediatric clinic populations to be 5.5% among new child and adolescent psychiatry intakes 13 and 17.8% among patients with related disorders, 14 including comorbid medical, neurodevelopmental, psychotic, and genetic conditions 15-18 …”

“…12 Recent reports, however, suggest the prevalence of catatonia in outpatient pediatric clinic populations to be 5.5% among new child and adolescent psychiatry intakes 13 and 17.8% among patients with related disorders, 14 including comorbid medical, neurodevelopmental, psychotic, and genetic conditions. [15][16][17][18] Children with catatonia are at elevated risk for a missed diagnosis as they often present with distinct symptoms and physical examination findings not seen in adult catatonia. Examples include urinary incontinence, loss of previously acquired skills/communicative abilities, acrocyanosis, automatic compulsive movements, and schizophasia.…”

Pediatric Clinical Classification System for use in Canadian inpatient settings

“…In the US, PECCS has been used in studies to group diagnosis codes of pediatric hospital encounters into mutually exclusive condition categories in children’s hospitals exclusively [ 12 ], and in general and children’s hospitals [ 13 ] to identify high priority conditions based on prevalence and costs. It has also been used to identify high priority conditions in pediatric ambulatory surgeries [ 14 ], and to classify the comorbidities present in pediatric patients hospitalized with catatonia [ 15 ]. Several countries have created their own clinically modified ICD-10 classification system to address their country-specific needs [ 16 ].…”