Retrospective cross-sectional study of 5.37 million weighted pediatric mental health-related ED visits among children aged 5–17 years (2016–2022), examining how patient and hospital characteristics relate to presenting at high-volume pediatric EDs (≥10,000 annual pediatric visits) using the Nationwide Emergency Department Sample.
Half (50.1%) of visits occurred at high-volume EDs. Non-Hispanic Black children had higher adjusted odds of presenting to high-volume EDs (aOR 1.19, 95% CI 1.05–1.35), while Native American children had lower odds (aOR 0.54, 95% CI 0.35–0.83), both compared to non-Hispanic White children. Substance-related diagnoses were less likely to present to high-volume EDs than suicide/self-injury visits (aOR 0.79, 95% CI 0.71–0.87).
Cross-sectional design limits causal inference. The study uses administrative ICD-10-CM codes, which may misclassify diagnoses. Data on mental health service availability, boarding times, or ED-level interventions are not captured.
Significant racial and diagnostic disparities exist in where children receive mental health emergency care — Native American children and those with substance-related diagnoses are less likely to reach high-volume, potentially better-resourced EDs. Targeted outreach and resource deployment to low- and medium-volume EDs may be needed to close these gaps.
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