Diagnostic Trends of Minors in Psychiatric Emergency Care: An Observational Study.
Diagnostic stability in child and adolescent psychiatry is a key indicator of validity and essential for clinical decision-making. Few longitudinal studies have examined diagnostic trajectories after a first emergency psychiatric contact.
We conducted a retrospective observational cohort study at Santa Maria University Hospital (Lleida, Spain). A total of 583 patients aged 4-18 years presenting for their first psychiatric emergency visit between 2017 and 2023 were included, with 24-month follow-up. Sociodemographic and clinical data were extracted from Electronic Health Records. Diagnostic transitions were summarized using transition matrices. An exploratory association analysis (Apriori algorithm) identified frequent T1→T2 patterns, reported with confidence and lift. Diagnostic stability was defined as the proportion of patients retaining the same diagnosis at follow-up.
Median age at baseline 14.9 years (interquartile range [13-16]); 54.55% were female. Schizophrenia/psychosis showed the highest stability (71%), followed by intellectual disability with gender identity disorder (67%). Mood disorders showed moderate stability (~44%), while others such as eating disorders (26%) or conduct disorders (17%) had lower stability. The strongest associations were "no prior diagnosis → eating disorder" (confidence = 1.00; lift = 12.76) and "autism spectrum disorder + attention-deficit/hyperactivity disorder (ADHD) → conduct disorders" (confidence = 0.66; lift = 2.55).
Diagnostic stability is heterogeneous, with high persistence in schizophrenia/psychosis and low in eating disorders and ADHD. Association analysis identified specific trajectories that may help anticipate clinical evolution. Findings highlight the importance of longitudinal evaluation in early psychiatric care.
We conducted a retrospective observational cohort study at Santa Maria University Hospital (Lleida, Spain). A total of 583 patients aged 4-18 years presenting for their first psychiatric emergency visit between 2017 and 2023 were included, with 24-month follow-up. Sociodemographic and clinical data were extracted from Electronic Health Records. Diagnostic transitions were summarized using transition matrices. An exploratory association analysis (Apriori algorithm) identified frequent T1→T2 patterns, reported with confidence and lift. Diagnostic stability was defined as the proportion of patients retaining the same diagnosis at follow-up.
Median age at baseline 14.9 years (interquartile range [13-16]); 54.55% were female. Schizophrenia/psychosis showed the highest stability (71%), followed by intellectual disability with gender identity disorder (67%). Mood disorders showed moderate stability (~44%), while others such as eating disorders (26%) or conduct disorders (17%) had lower stability. The strongest associations were "no prior diagnosis → eating disorder" (confidence = 1.00; lift = 12.76) and "autism spectrum disorder + attention-deficit/hyperactivity disorder (ADHD) → conduct disorders" (confidence = 0.66; lift = 2.55).
Diagnostic stability is heterogeneous, with high persistence in schizophrenia/psychosis and low in eating disorders and ADHD. Association analysis identified specific trajectories that may help anticipate clinical evolution. Findings highlight the importance of longitudinal evaluation in early psychiatric care.
Authors
Jiménez-Mayoral Jiménez-Mayoral, Florensa Florensa, Llorca-Bofí Llorca-Bofí, Irigoyen-Otiñano Irigoyen-Otiñano
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