Emergency and urgency in pediatric subjects with neuropsychiatric disorders: a pilot study in a tertiary center

Rationale: Increasing Emergency department (ED) presentations for neuropsychiatric disorders has been documented in recent years (SINPIA Regional Section Lazio 2014), as a result of both a contraction of mental health resources, especially for children and adolescents, and a lower family and social containment. Factors associated with this phenomeon appear to be multiple, complex and inter-related. Moreover, the interaction among health facilities (community health services [ASL], hospitals, tertiary centers and ED) is not always effective.The goal of this study is to describe the management of neuropsychiatric disorders in ED and to identify the care pathways used in the post acute phase.Methods: We included subjects aged <18 years admitted to general and pediatric ED of Policlinico Umberto I in Rome, from January to December 2013, for whom a neurological or psichiatric consultancy was requested. The project has been divided in three phases: I) Collection of personal information of patients admitted to General or Pediatric ED in 2013 and for whom has been required a neurological or psychiatric consultancy; II) Sending to these patients' parents an introductory letter about the study and a facsimile of a questionnaire, aimed to investigate the evolution of the clinical conditions, the taking charge of the patient and any further access to ED; III) Telephone interview from January 2015 to March 2015, administering the questionnaire previously sent. Results: In 2013, 432 subjects received a neurological or psychiatric consultancy (223 males): 383 (89%) for neurological symptoms and 49 (11%) for psychiatric symptoms. Over the whole sample, 277 patients phone contacts were available, while 255 completed the questionnaire (drop-out 6.5%).99 patients (39%) had paroxysmal events, 39 (15%) headache, 31 (12%) motor and/or sensory disorders, 20 (8%), anxiety disorders, 16 (6%) behavioural disorders, 7 (3%) psychosis, 5 (2%) self harm and 38 (15%) not neurological or psychiatric diagnosis. Patients with psychiatric symptoms were admitted as: • 10 red code; 4 were hospitalized (3 patients in Child Neuropsychiatric [NPI] Service, 1 patients in SPDC service) and 2 were followed in outpatients services in NPI Dpt; • 26 yellow code; 5 were hospitalized in NPI service; • 11 green code. Patients with neurological symptoms were admitted as: • 5 red code; 4 were hospitalized (1 patients in NPI service, 3 patients in Pediatric service); • 108 yellow code; 40 were hospitalized (7 patients in NPI service, 20 patients in Pediatric service and 3 in Neurology service) • 52 green code • 4 white code.63% of psychiatric and 27% of neurological patients had a NPI diagnosis before the admission in ED. After the ED admission and neurological or psychiatric consultancy, the taking charge in tertiary centers increased for psychiatric patients, while the taking charge of neurological patients increased in all facilities (ASL, tertiary centers and private consultants equally). Conclusions: The study identifies the neuropsychiatric disorders that were mostly admitted in a tertiary center ED. Moreover, it shows how the number of NPI patients greatly overcomes the availability of the NPI hospital resources in emergency/urgency