Prehospital Management of Pediatric Behavioral Health Emergencies: A Scoping Review.

Pediatric behavioral health emergencies (BHE) are increasing in prevalence, yet there are no evidence-based guidelines or protocols for prehospital management. The primary objective of this scoping review is to identify prehospital-specific pediatric BHE research and publicly available emergency medical services (EMS) protocols for pediatric BHE. Secondary objectives include identifying the next priorities for research and EMS protocol considerations for children with neurodevelopmental conditions. This is a scoping review comprised of a research literature search for publications from 2012-2022 and an internet search for publicly available EMS protocols from the United States. Included publications contain data on the epidemiology of pediatric BHE or describe prehospital management of pediatric BHE. EMS protocols were included if they had advisements specific to pediatric BHE. A total of 50 research publications and EMS protocols from 43 states were screened. Seven publications and four protocols were included in this study. Research studies indicated an increase in pediatric BHE over the last decade, but few papers discuss current prehospital management (n=4). Two EMS protocols were specific to pediatric BHE or pediatric agitation, and the other two EMS protocols focused on adult populations with integrated pediatric recommendations. All four EMS protocols encouraged nonpharmaceutical interventions prior to the use of pharmacologic restraints. Although there is a substantial rise in pediatric BHE, there is sparse research data and clinical EMS protocols to support best practices for prehospital pediatric BHE management. This scoping review identifies important future research aims to inform best practices for the prehospital management of pediatric BHE.

Implementing the evidence: Routine screening for depression and anxiety in primary care.

Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment.

Early hospital discharge and early puerperal complications.

OBJECTIVE: To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. MATERIALS AND METHODS: Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (<24 hours) or late (>25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. RESULTS: Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). CONCLUSIONS: There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

Early hospital discharge and early puerperal complications / Egreso temprano postparto y complicaciones en el puerperio mediato

OBJECTIVE:To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. MATERIALS AND METHODS: Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (<24 hours) or late (>25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. RESULTS:Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). CONCLUSIONS:There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

OBJETIVO:Evaluar la asociación entre el tiempo de egreso posparto y las posibles complicaciones en el puerperio mediato. MATERIAL Y MÉTODOS:Mujeres con parto vaginal atendidas en un hospital público de la Ciudad de México, sin complicaciones antes del egreso hospitalario, fueron entrevistadas a los siete días de egreso. La variable dependiente fue la ocurrencia y severidad de complicaciones. Se calcularon media y desviación estándar para las variables continuas, y proporciones para las categóricas. Las variables relacionadas con egreso temprano en el análisis bivariado (con p<0.15) fueron incluidas en un modelo de regresión logística. RESULTADOS:Se analizó información de 303 partos, de los cuales 208 (68%) tuvieron egreso temprano posparto. Las mujeres que fueron egresadas en forma temprana con un control prenatal adecuado reportaron menos síntomas de complicaciones en el puerperio mediato (RM= 0.36; IC 95% = 0.17-0.76). CONCLUSIONES:Aunque no se encontró asociación entre el egreso temprano y los síntomas de complicaciones durante la primera semana del posparto, el riesgo de complicaciones fue menor en mujeres con egreso temprano y con cuidado prenatal adecuado, comparadas con las mujeres que presentaron egreso tardío sin control prenatal.