Clinical and sociodemographic predictors of inpatient admission after presentation in a psychiatric emergency room: an observational study

Abstract

Abstract Background The admission decision after presentation in the psychiatric emergency room (PER) has potentially far-reaching consequences for the patient and the community. In a short amount of time, information must be collected and evaluated for a well-founded admission decision. The present study aimed to identify risk factors associated with inpatient psychiatric admission (IPA) after previous emergency presentation to the PER. Methods Electronic patient records for all patients presenting in the PER of Hannover Medical School (MHH) in the year 2022 were retrospectively examined (n = 2580). Out of these, 2387 were included in this study. Two multivariate binary logistic regression analyses were performed to identify risk factors for IPA within sociodemographic, circumstantial and clinical variables. Results 1300 (54.5%) consultations resulted in IPA. The most significant sociodemographic and circumstantial risk factors for IPA were found to be suicide attempt (depending on method: OR 9.1–17.4), aggressive behavior towards people prior to presentation (OR 2.9, 95% CI 1.7–4.8), previous psychiatric treatment (OR 1.8, 95% CI 1.4–2.3) and transfer from another hospital or medical discipline of MHH as means of presentation (OR 6.3, 95% CI 3.0–13.0). Among psychopathological aspects, suicidal ideation (OR 3.8, 95% CI 2.9–4.9), suicidal intent (OR 116.0, 95% CI 15.9–844.8), disturbance of orientation (OR 3.7, 95% CI 2.5–5.3), delusions (OR 2.3, 95% CI 1.6–3.1), visual hallucinations (OR 2.9, 95% CI 1.6–5.1), hopelessness/despair (OR 2.4, 95% CI 1.7–3.2) and inhibition of drive (OR 1.6, 95% CI 1.3–2.1) were significantly associated with IPA. Conclusions The admission decision is a complex process influenced by a multitude of sociodemographic, circumstantial and clinical factors. A deeper understanding of the decision-making process can be used to improve patient care and facilitate the evaluation process in the PER.

Keywords

• Emergency psychiatry
• Admission predictor
• Discharge
• Suicide
• Suicide attempt
• Self-harm