Emergency physician referrals to the pediatric crisis clinic: reasons for referral, diagnosis and disposition.

OBJECTIVE: To describe the patient population, diagnoses, and disposition of children and adolescents referred by Pediatric Emergency Medicine (PEM) physicians to a Pediatric Psychiatric Crisis Clinic (PCC) for urgent consultation; to describe the percent agreement between PEM physician discharge diagnosis and subsequent child psychiatrist diagnoses.
METHOD: Data were obtained prospectively over a one-year period for consecutive patients referred to the PCC (n=174). Patients and families were contacted for information regarding subsequent emergency department (ED) visitation following PCC consultation.
RESULTS: Referred patients were commonly male (63%) with a mean age of 12.2 ± 3.2 years diagnosed with adjustment disorder (29%), mood disorder (17%) and anxiety disorder (17%) and significant psychosocial stressors. Five percent of patients required hospitalization. PEM physician discharge diagnosis and child psychiatrist diagnosis were in agreement in 21% of cases.
CONCLUSION: Patients referred by PEM physicians for urgent outpatient psychiatric assessment were most commonly early adolescent males. The majority of patients did not require ongoing psychiatric care. Further investigation into the differences between PEM physician and child psychiatrist diagnoses is needed to ensure patients and families receive accurate and consistent mental health information and recommendations from all members of their health care team.