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

  • Punit Virk (a1) (a2), Dzung X. Vo (a2) (a3), Jacob Ellis (a4) and Quynh Doan (a1) (a2) (a5)

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.

RésuméContexte

La somatisation est un phénomène courant, qui peut grandement perturber la santé et le fonctionnement des jeunes. Toutefois, on ne connaît pas très bien, à l'heure actuelle, le fardeau de la somatisation dans les milieux de soins actifs en pédiatrie; si on en avait une meilleure idée, cela pourrait aider les cliniciens à surmonter les difficultés que pose le traitement efficace des patients touchés. L'étude visait donc à estimer la prévalence de la somatisation dans un service des urgences (SU) pédiatriques.

Méthode

Il s'agit d'une étude transversale, rétrospective, portant sur des consultations pour des troubles ne nécessitant pas des soins de toute urgence et non en lien avec la santé mentale (n = 150), faites entre juillet 2016 et août 2017, dans un SU pédiatriques de soins quaternaires. Une collecte de données démographiques et de renseignements d'ordre clinique a été réalisée à l'aide d'un examen des dossiers médicaux, puis soumise au jugement de deux cliniciens afin qu'ils déterminent si, pour chacune des consultations, il y avait un élément «probable», «possible (incertain)» ou «peu probable» de somatisation.

Résultats

Dans environ 3,33% des cas (n = 5), il y avait une somatisation probable et, dans 13,33% de cas additionnels (n = 20), il y avait une somatisation possible mais, pour s'en assurer, il faudrait consulter d'autres documents sur l'état psychosocial et les consultations ultérieures. La présence prolongée de symptômes et l'accumulation d'examens de diagnostic négatifs étaient associées à une probabilité accrue de somatisation probable ou possible.

Conclusion

Une proportion importante de consultations pour des troubles non en lien avec la santé mentale pourrait comporter un élément de somatisation, ce qui autorise à penser que le fardeau des troubles mentaux au SU pourrait être sous-estimé. Ainsi, une vigilance accrue devant de possibles signes de somatisation pourrait aider les cliniciens à traiter les personnes affectées.

Copyright

Corresponding author

Correspondence to: Dr. Quynh Doan, Faculty of Medicine, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, CANV6T 1Z3; Email: qdoan@bcchr.ca

References

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

  • Punit Virk (a1) (a2), Dzung X. Vo (a2) (a3), Jacob Ellis (a4) and Quynh Doan (a1) (a2) (a5)

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