Quality of Life for Children With Mental and Behavioral Health Emergencies in the Pediatric Emergency Department

Abstract

Objective: Hospital encounters affect the Quality of Life (QoL) of children with medical illness, but less is understood about the QoL in children with mental/behavioral health (MBH) emergencies while boarding in the pediatric emergency department (PED). Our objective was to examine QoL among children with MBH emergencies in the PED.

Methods: We conducted a prospective, observational study in an urban PED from December 9, 2021, to December 9, 2022, enrolling youth ages 8 to 17 years with MBH emergencies. Control subjects included patients with concern for extremity fracture or chronic medical illness. We compared baseline QOL scores and QOL trajectories using the validated Pediatric Quality of Life Present Functioning Visual Analogue Scale. We analyzed data using the Wilcoxon rank sum test and performed multivariable linear regression to compare QoL total symptom score outcomes between MBH and control patients, adjusting for patient characteristics.

Results: We enrolled 112 MBH and 111 control patients. Patients with MBH emergencies had worse QoL at presentation (54 vs. 41, P<0.001) and disposition (49 vs. 24, P<0.001). They had less QoL improvement (-3 vs. -11, P<0.001), with 24% (27/112) showing no improvement and 29% (32/112) with worse QoL at disposition. In the multivariable regression model, patients with MBH emergencies had less QoL total symptom score improvement compared with controls (P=0.02).

Conclusions: Patients with MBH emergencies showed no improvement or worse QoL in the PED, highlighting the need to prioritize improving their emergency care experience.

Keywords: boarding; emergency medicine; mental health; quality of life.