Keypoint: The total number of psychotropic medications administered during pediatric emergency department encounters rose by 624% from 2013 to 2022.
The use of psychotropic medications during pediatric mental and behavioral health (MBH) encounters in emergency departments has increased from 2013 to 2022, according to study results published in Pediatrics. However, psychotropic medication use significantly varies across hospitals, indicating a need for standardization in emergency department management to improve quality of care.
Although previous studies have shown that psychotropic medication is frequently used during MBH visits in pediatric emergency departments, there is a lack of information regarding potential variability in psychotropic medication administration at the hospital level. Therefore, researchers conducted a retrospective cross-sectional study to evaluate changes in psychotropic medication use over time across pediatric hospitals in the United States.
The researchers used data from 2013 to 2022 in the Pediatric Health Information System to identify MBH encounters (validated using International Classification of Disease [ICD] codes) among patients aged 3 to 21 years in emergency departments across the US. Eligible psychotropic medications included psychotherapeutics (anxiolytics, antidepressants, antipsychotics), stimulants, anticonvulsants, antihistamines, and antihypertensives.
Over the study period, there were 670,911 emergency department encounters involving youth with primary MBH diagnoses and 12.3% of these encounters involved psychotropic medication administration. The pediatric patients in these encounters were mostly girls (57.5%), White (59.2%), non-Hispanic (75.8%), publicly insured (53.3%), and aged 13 to 17 (62.8%) years. The most common MBH diagnoses were depressive disorders (24.9%), suicide/self-injury (22.9%), and disruptive behavior disorders (9.4%). However, the highest frequency of psychotropic medication administration was observed among individuals with intellectual disabilities (25.4%) and autism spectrum disorders (25.3%).
The researchers found that psychotropic medication administration during emergency department visits increased from 7.9% in 2013 to 16.3% in 2022 among pediatric patients, and the odds of psychotropic medication administration increased each year (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). The total number of psychotropic medications administered during emergency department MBH encounters rose by 624% from 2013 (n=6652) to 2022 (n=48,174), with a yearly incidence rate ratio of 1.11 (95% CI, 1.09-1.15). The researchers noted significant increases in psychotropic medication administration across all age groups for most psychotropic medication categories, except anxiolytics.
However, the researchers observed significant variability in the percentage of MBH encounters involving psychotropic medication across hospitals, ranging from 4.2% to 23.1% (P <.001). Similarly, the total number of psychotropic medications administered varied from 81 per 1000 MBH encounters to 792 per 1000 MBH encounters (P <.001).
“Across the study period, the proportion of MBH encounters with at least 1 psychotropic medication administered doubled, and the total number of psychotropic medications administered in the ED increased nearly sevenfold,” the researchers noted. “Inconsistent practice patterns indicate that opportunities are available to standardize ED management of pediatric MBH conditions to enhance quality of care.”
Study limitations include a lack of data confirming whether medications were successfully administered and potential misclassification of diagnoses and demographic characteristics.
Note: This article originally appeared on Psychiatry Advisor
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