- Design
- Retrospective cross-sectional study, national ED sample
- Population
- 5.4 million weighted mental health ED visits, ages 5-17, US 2016-2022
- Primary outcome
- Presentation to a high-volume paediatric ED
- Effect
- 50.1% at high-volume EDs; substance-related aOR 0.79 vs self-injury
A cross-sectional study in Annals of Emergency Medicine (September 2026) used the US Nationwide Emergency Department Sample from 2016 to 2022 to examine 5.4 million weighted ED visits by children aged 5 to 17 with a primary mental health diagnosis.
Half (50.1%) were to EDs seeing 10,000 or more children a year; the rest were spread across lower-volume departments, 4.7% to the lowest-volume ones. Black children had higher odds (aOR 1.19) and Native American children lower odds (0.54) of presenting to high-volume EDs than White children. Substance-related presentations were less likely than suicide and self-injury to go to high-volume departments (aOR 0.79).
The data are US-specific and administrative. The point that transfers is simple: half of children in mental health crisis are seen in general EDs that see relatively few children, which need their own pathway.
- Expect children in mental health crisis in general EDs, not only paediatric centres
- Have a protocol for suicide and self-harm assessment in children in every ED
- Screen adolescents presenting with intoxication for self-harm and suicidal intent
- Know the local route to child and adolescent mental health services out of hours
Why it matters
It shows paediatric mental health emergencies are a general ED problem, not one confined to children's hospitals.
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