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We recorded age, gender, symptoms, triage acuity, and ED investigations and management plan of consented participants. We measured feasibility as (1) the proportion of positive screens who agreed to meet the study psychiatrist to learn about the mind-body connection, (2) the proportion who then consented to further psychiatric assessment, (3) among consenting positive screens, the proportion the psychiatrist supported as likely involving a somatization component (agreed with screening results), and invited to psychoeducational follow-up, and (4) the proportion who attended follow-up. These families were also invited to a psychoeducational follow-up session. Those that met the study psychiatrist were offered additional assessment, to further corroborate likelihood of somatization affecting the patient. The ED clinician then used a script to help introduce the mind-body connection to positively screened patients and their families and invited them to meet a study psychiatrist to learn more. First, an ED clinician completed a brief somatization screening tool. Our secondary objective was to measure the feasibility of our approach to identify, introduce, and follow up with somatization in the pediatric ED. Utility was measured as the proportion of patients screening positive for somatization on a short, standardized ED clinician-completed questionnaire. The primary objective of the study was to estimate the clinical utility of universal screening for somatization in the pediatric ED. The current study describes this approach and evaluates its utility and feasibility for universal screening and psychoeducational referral in a pediatric ED. To address this need, we developed a standardized approach to identifying and managing somatization in pediatric acute care, drawing from best practices, and expertise in mental health care ( Garralda & Rask, 2015 Ibeziako et al., 2019 Malas et al., 2017). To our knowledge, no screening tool has been specifically designed, modified, or validated for pediatric ED use. However, carrying out lengthy assessments may be impractical for emergency personnel, and doing so could disrupt patient flow and contribute to existing ED challenges such as overcrowding.īrief clinical screening may be an effective alternative to lengthy assessments in rapidly identifying potential somatic presentations before the initiation of excessive diagnostic testing. Early identification of somatization is important in order to avoid excessive medical workup and to help facilitate transition to appropriate mental health services ( Barsky & Borus, 1999 Dworetzky et al., 2015 Furness et al., 2009 LaFrance & Benbadis, 2006 Mayou et al., 2000 Stephenson & Price, 2006 Stone et al., 2009). Somatization is not routinely recognized in the ED, as prioritization of serious physical symptoms may overshadow identification of underlying psychological distress ( Stephenson & Price, 2006). The rising number of mental health-related visits across pediatric emergency departments ( Canadian Institute for Health Information, 2015 Mapelli et al., 2015 Sills & Bland, 2002), coupled with evidence that physical complaints can also involve underlying mental health concerns, suggests that a number of ED visits may implicate some component of somatization ( de Gusmão et al., 2014 Gelauff et al., 2014). Youth experiencing somatizing complaints incur high health care costs associated with more frequent health care utilization, including primary and acute care visits, inpatient admissions, and specialist consultations ( Saunders et al., 2020).
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Somatization is a normal phenomenon, but sometimes has short-or long-term impacts on health and functioning, including developmental impairment, mental health disorders, reduced school attendance, and poor academic performance ( Beck, 2008 Offord et al., 1987). Population-level studies have shown somatization to be common, estimating that up to 50% of the general pediatric population experience at least one somatic symptom at some point ( Campo & Fritsch, 1994 Lieb et al., 2000).
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Somatization represents the interaction of psychological and biological processes in producing unintentional physical symptoms that can occur either in the presence or absence of verifiable physical illness ( Lipowski, 1988).