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

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.