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CJEM. 2020 Feb 10:1-7. doi: 10.1017/cem.2019.477. [Epub ahead of print]

Pediatric somatization in the emergency department: assessing missed opportunities for early management.

Virk P1,2, Vo DX2,3, Ellis J4, Doan Q1,2,5.

Author information

1
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC.
2
BC Children's Hospital Research Institute, Vancouver, BC.
3
Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC.
4
Division of Child & Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC.
5
Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC.

Abstract

OBJECTIVE:

Somatization is a common phenomenon that can severely complicate youths' functioning and health. The burden of somatization on pediatric acute care settings is currently unclear; better understanding it may address challenges clinicians experience in effectively caring for somatizing patients. In this study, we estimate the prevalence of somatization in a pediatric emergency department (ED).

METHODS:

We conducted a retrospective cross-sectional study of visits for non-critical, non-mental health-related concerns (n = 150) to a quaternary-level pediatric ED between July 2016 and August 2017. Demographic and clinical visit details were collected through chart review and used by two reviewing clinicians to classify whether each visit had a "probable," "unclear" (possible), or "unlikely" somatizing component.

RESULTS:

Approximately 3.33% (n = 5) of youth displayed probable somatization, and an additional 13.33% (n = 20) possibly experienced a somatizing component but require additional psychosocial and visit documentation to be certain. Longer symptom duration and multiple negative diagnostic tests were associated with a higher likelihood of either probable or possible somatization.

CONCLUSIONS:

A considerable proportion of non-mental health-related visits may involve a somatizing component, indicating the burden of mental health concerns on the ED may be underestimated. A higher index of suspicion for the possibility of somatization may support clinicians in managing somatizing patients.

KEYWORDS:

Child and adolescent; emergency department; medically unexplained symptoms; somatization

PMID:
32037998
DOI:
10.1017/cem.2019.477

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