Study objectives Pediatric mental health emergency department (ED) visits are increasing, yet differences in presentations by ED type are not well described. Our objective was to examine characteristics of pediatric mental health-related ED visits by annual pediatric ED volume. Methods We conducted a retrospective cross-sectional study of ED visits among children 5 to 17 years with a primary mental health diagnosis, identified by International Classification of Diseases, Tenth Revision, Clinical Modification codes, using the 2016 to 2022 Nationwide Emergency Department sample. The outcome was presentation to an ED with high annual pediatric volume (≥10,000 visits). Using multivariable logistic regression modeling, we examined the association with patient- and hospital-level characteristics, reporting adjusted odds ratios and 95% confidence intervals (CIs). Results We identified 5,369,821 weighted mental health-related visits (4.7% low, 21.2% medium, 24.1% medium-high, and 50.1% high annual pediatric volume). The adjusted odds of presenting to a high compared with a low/medium/medium-high annual pediatric volume ED were higher among non-Hispanic Black (1.19, 95% CI 1.05, 1.35) and lower among Native American (0.54, 95% CI 0.35, 0.83) children compared with non-Hispanic White children. The adjusted odds were lower for individuals with substance-related diagnoses (0.79, 95% CI 0.71, 0.87) compared with those with suicide and self-injury. Conclusion Pediatric mental health-related ED visits vary by patient characteristics and diagnoses across EDs with different annual pediatric volume categories. Findings may inform opportunities to develop and deploy ED-based interventions to improve pediatric mental health outcomes across diverse populations and settings.
STUDY OBJECTIVE:To apply Autor's labor economics task framework to classify emergency physician tasks by automation susceptibility and map current artificial intelligence (AI) capabilities to each category. METHODS:We synthesized 6 published time-motion studies, ACGME Core Entrustable Professional Activities, and the O∗NET emergency physician task inventory into a unified list of 14 task categories. Two board-certified emergency physicians independently classified each task using Autor's 4-category framework. Current AI capabilities were mapped to each task using a 3-tier schema: Replace, Augment, or No Current Application. RESULTS:Nine tasks (64.3%) were classified as nonroutine abstract, 3 (21.4%) as routine cognitive, and 2 (14.3%) as nonroutine manual. No tasks were Routine Manual. AI replacement is concentrated in routine cognitive tasks (documentation, medical records review, emergency department operations management), which consume 20% to 40% of physician shift time. Augmentation dominates in nonroutine abstract domains. Nonroutine manual tasks show minimal AI penetration. CONCLUSION:Routine cognitive tasks consume a disproportionate share of emergency physician shift time, making them the immediate target for AI-driven workflow restructuring. Beyond this, augmentation of nonroutine abstract tasks is accelerating, warranting ongoing reassessment of automation boundaries across all task categories. As AI capabilities continue to expand, structured task-level analyses of this kind will be essential for anticipating workforce needs and informing AI implementation strategy, residency training design, and physician preparation in emergency medicine.
Study objectives Adolescents with severe agitation may require repeated administration of sedatives. We describe dexmedetomidine infusion as a novel bridge therapy for selected agitated adolescents awaiting psychiatric treatment and disposition. Methods We retrospectively studied adolescents (12 to 17 years) treated with dexmedetomidine infusion for severe agitation at our emergency department (ED) over a 16-month period. We abstracted demographics, sedatives administered, psychiatric therapy, type and frequency of adverse events, and ED disposition. Our primary outcome was the need for additional sedation despite dexmedetomidine. Results The median age of our 20 qualifying patients was 15 years. The median duration of dexmedetomidine infusion was 21 hours, with a median maximum dose of 1.6 mcg/kg per hour. During the infusion, 9 patients (45%, 95% confidence interval 26% to 66%) required additional sedation. One patient experienced desaturation responding to head repositioning and supplemental oxygen. Five patients were transferred to the pediatric ICU owing to the need of multiple sedatives. Conclusion Our preliminary results support the feasibility of dexmedetomidine infusion as bridge sedation for selected severely agitated adolescents awaiting psychiatric care and disposition.
