Journal Article Annotations
2020, 4th Quarter

Child and Adolescent Psychiatry/ Pediatrics

Annotations by Jeylan Close, MD
December, 2020

Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity.

PUBLICATION #1 — Child and Adolescent Psychiatry/ Pediatrics

Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity.

Aaron Wiggins, Andrew Court, Susan M Sawyer.

Abstract: Eur J Pediatr. 2020 Nov 13. doi: 10.1007/s00431-020-03867-2. Online ahead of print.

Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children’s hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.

Annotation

The finding:
The authors did a chart review in a tertiary children’s hospital to identify patients with a diagnosis of somatic symptoms and related disorders (SSRD) and examined a variety of patient characteristics, as well as what was involved in their care throughout their hospital stay. Notable patient characteristics included multiple SSRD symptoms in 76%, a medical comorbidity in 65%, and psychiatric comorbidity in 46%. In looking at external factors, they found that 80% had SSRD symptoms that overlapped with a family member’s diagnosed medical illness and 75% had a precipitating emotional stressor. They found that the rates of interventions such as interdisciplinary and family meetings compared to what is recommended by the AACAP’s SSRD clinical pathway was suboptimal. Of patients with functional neurologic symptoms, 70% had a listed somatic discharge diagnosis, compared to 40% of patients with non-neurologic somatic symptoms. One in three patients were readmitted during the 18 month study period.

Strength and weaknesses:
Limitations include retrospective data collection, use of only a single site, and reliance on identifying SSRD by diagnosis in the chart. The authors could not comment on whether any noted characteristics of patients with SSRD have an impact on clinical course. Additionally, they did not develop a treatment pathway or determine if one was effective. Strengths include examining multiple aspects of the clinical picture including incidences of consults, multidisciplinary meetings, individual symptoms, and social and family history.

Relevance:
Consistent with the authors’ findings, SSRD is a common diagnosis of patients admitted to pediatric hospitals. SSRD is the second most common diagnosis leading to Child Psychiatry consultation. Furthering understanding of common characteristics of these patients may aid in elucidating improved methods of early identification, which could decrease burden on patients, families, and hospitals. Additionally, this paper exemplifies an approach to examining implementation of recommended clinical pathways and identifying areas for improvement to enhance quality of care.

Type of study (EBM guide):
Case series or report