Does a standard triage tool adequately detect the needs of children and adolescents admitted for mental health problems?

Background: The visits to the Pediatric Emergency Department for mental problems are increasing exponentially; however, due to the lack of adequate training, the emergency department team in not ready enough to manage them. This study aimed to evaluate how the Italian Society of Pediatric Emergency Medicine and Urgency triage system was able to estimate urgency in patients accessing to the Pediatric Emergency Department for a mental health problem.

Methods: We conducted a retrospective study at the Emergency Department of the IRCCS Materno Infantile Burlo Garofolo of Trieste (Italy), from December 2015 to April 2017. During the study period, we identified all the patients undergoing urgent psychiatric consultation. We collected demographic variables, triage code, diagnosis, and outcomes of each patient. Subsequently, we have assigned a degree of psychiatric urgency, based on Gail and Rosenn's Classification which is a specific tool to evaluate psychiatric urgency. The primary study outcome was the comparison between the degree of urgency assigned using the triage system and the Gail and Rosenn's Classification.

Results: In this series, 567 patients underwent urgent psychiatric consultation, and 280 of them received a diagnosis of a mental health problem. The degree of urgency assigned at the triage was: emergency for 5 cases (2%), urgency for 96 (34%) and non-urgency for 179 (64%). Instead, the degree assigned with GRC was: emergency for 95 cases (34%), urgency for 112 (42%) and non-urgency for 73 (26%). The number of patients, detected as emergency and urgency by the two tools, was significantly different (P=0.0001).

Conclusions: In this study, we demonstrated that the Italian Society of Pediatric Emergency Medicine and Urgency triage system underestimated the urgency of patients with mental health problems compared to a specific tool to assess the degree of psychiatric urgency.