Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders.
Document Type
Article
Publication Date
2-1-2020
Publication Title
Hospital Pediatrics
Abstract
OBJECTIVES: The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care. Little literature exists to address SSRDs in the inpatient pediatric setting. The purpose of the study was to characterize current SSRD practice, identify problem areas in workflow, and develop a standardized approach to inpatient evaluation and management at a tertiary care academic children's hospital.
METHODS: A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014. A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice. Lean methodology was used to define current state practice and future state intervention. These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.
RESULTS: Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review. Most patients presented with either neurologic or pain-related complaints. The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalization. Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis. Half of patients had comorbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.
CONCLUSIONS: In this study, we describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of pediatric SSRDs. This study may serve as a model for similar standardization of SSRD care in other inpatient pediatric medical settings.
Volume
10
Issue
2
First Page
105
Last Page
113
Recommended Citation
Kullgren KA, Shefler A, Malas N, Monroe K, Leber SM, Sroufe N, El Sakr A, Pomeranz E, O'Brien E, Mychaliska KP. Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hosp Pediatr. 2020 Feb;10(2):105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2. PMID: 31896546.
DOI
10.1542/hpeds.2019-0141
ISSN
2154-1671
PubMed ID
31896546