Background
Objective
Methods
Data source
Inclusion and exclusion criteria
Measures
Predictors
Outcome
Data management
Handling of missing data
Statistical analysis
Descriptive analysis
Measures of association
Prediction modeling
Subgroup analysis
Characteristics | Full sample % (95% CI) | ED visit % (95% CI) | No ED visits % (95% CI) |
---|---|---|---|
Age in years (mean/SD) | 12.1 (4.3) | 12.6 (4.2) | 11.7 (4.3) |
Sex | |||
Male | 44.7 (43.5,46.0) | 40.4 (38.5,42.4) | 47.8 (46.2,49.4) |
Female | 54.2 (53.0,55.5) | 58.2 (56.3,60.1) | 51.4 (49.7,53.0) |
Neither male/female | 1.1 (0.8,1.4) | 1.4 (1.0,1.9) | 0.8 (0.6,1.2) |
Residence | |||
Rural | 4.8 (4.3,5.4) | 3.5 (2.9,4.3) | 5.8 (5.0,6.6) |
Urban | 89.5 (88.7,90.3) | 91.8 (90.7,92.8) | 87.9 (86.8,89.0) |
Unclassified/unknown | 0.8 (0.6,1.0) | 0.6 (0.4,1.0) | 0.9 (0.6,1.2) |
Missing | 4.9 (4.4,5.4) | 4.1 (3.4,4.9) | 5.4 (4.7,6.2) |
Program type | |||
Community bed | 1.3 (1.1,1.6) | 1.8 (1.4,2.4) | 1.0 (0.7,1.3) |
Community clinic | 22.2 (21.2,23.3) | 21.6 (20.0,23.2) | 22.7 (21.3,24.1) |
Consultation service | 10.5 (9.7,11.3) | 10.8 (9.7,12.1) | 10.2 (9.3,11.3) |
Day treatment | 1.4 (1.1,1.7) | 1.2 (0.9,1.7) | 1.5 (1.2,2.0) |
Emergency service | 14.5 (13.6,15.4) | 17.6 (16.2,19.1) | 12.2 (11.2,13.3) |
Inpatient unit | 13.7 (12.8,14.5) | 17.7 (16.3,19.3) | 10.7 (9.8,11.8) |
Outpatient service | 16.3 (15.4,17.3) | 15.3 (14.0,16.8) | 17.0 (15.8,18.3) |
School-based service | 14.6 (13.7,15.5) | 9.0 (8.0,10.2) | 18.5 (17.3,19.8) |
Specialized service | 5.6 (5.0,6.2) | 4.9 (4.1,5.8) | 6.1 (5.3,6.9) |
Primary diagnosis | |||
Anxiety disorder | 24.3 (23.2,25.4) | 23.5 (21.9,25.1) | 24.9 (23.5,26.3) |
Bipolar disorder | 0.2 (0.1,0.4) | 0.2 (0.1,0.5) | 0.2 (0.1,0.4) |
Depressive disorder | 12.5 (11.7,13.4) | 15.0 (13.6,16.4) | 10.8 (9.8,11.8) |
Disruptive/impulse-control/conduct disorder | 1.5 (1.2,1.8) | 1.8 (1.3,2.4) | 1.3 (0.9,1.7) |
Feeding/eating disorder | 2.4 (2.0,2.8) | 2.2 (1.7,2.8) | 2.5 (2.1,3.1) |
Gender dysphoria | 0.2 (0.1,0.3) | 0.2 (0.1,0.5) | 0.2 (0.1,0.4) |
Medical disorder | 0.7 (0.5,0.9) | 0.7 (0.4,1.1) | 0.7 (0.5,1.0) |
Neurodevelopmental disorder | 19.5 (18.5,20.5) | 19.3 (17.8,20.9) | 19.7 (18.4,21.0) |
Obsessive-compulsive disorder | 1.6 (1.3,2.0) | 1.1 (0.8,1.6) | 2.0 (1.6,2.5) |
Other mental disorders | 4.2 (3.8,4.8) | 3.3 (2.7,4.1) | 4.9 (4.2,5.7) |
Personality disorder | 0.2 (0.1,0.4) | 0.2 (0.1,0.5) | 0.3 (0.1,0.5) |
Psychosocial factor | 17.3 (16.4,18.3) | 14.7 (13.4,16.2) | 19.1 (17.9,20.5) |
Schizophrenia/psychotic disorder | 0.7 (0.5,1.0) | 0.9 (0.6,1.4) | 0.6 (0.4,0.9) |
Somatic symptom | 0.3 (0.2,0.5) | 0.6 (0.3,0.9) | 0.2 (0.1,0.4) |
Substance-related disorder | 0.9 (0.7,1.2) | 1.2 (0.9,1.7) | 0.7 (0.5,1.0) |
Trauma/stress-related disorder | 13.1 (12.3,14.0) | 14.8 (13.5,16.2) | 12.0 (10.9,13.1) |
Others | 0.2 (0.1,0.3) | 0.3 (0.2,0.6) | 0.1 (0.0,0.3) |
Sensitivity analysis
Results
Descriptive
Characteristics | Full sample % (95% CI) | With ED visit % (95% CI) | Without ED visit % (95% CI) |
---|---|---|---|
Emotional abuse | |||
Yes | 26.5 (25.4,27.6) | 30.9 (29.1,32.7) | 23.3 (22.0,24.8) |
No | 71.1 (70.0,72.2) | 66.5 (64.6,68.3) | 74.4 (73.0,75.8) |
Missing | 2.4 (2.0,2.8) | 2.6 (2.1,3.3) | 2.2 (1.8,2.8) |
Physical abuse | |||
Yes | 13.6 (12.8,14.5) | 16.6 (15.2,18.1) | 11.4 (10.4,12.5) |
No | 83.4 (82.5,84.3) | 80.0 (78.4,81.5) | 85.9 (84.7,87.0) |
Missing | 3.0 (2.6,3.4) | 3.4 (2.8,4.2) | 2.7 (2.2,3.3) |
Sexual abuse | |||
Yes | 6.8 (6.2,7.5) | 8.8 (7.8,10.0) | 5.4 (4.7,6.2) |
No | 89.2 (88.4,90.0) | 86.2 (84.9,87.5) | 91.4 (90.4,92.2) |
Missing | 3.9 (3.5,4.5) | 5.0 (4.2,5.9) | 3.2 (2.7,3.8) |
Emotional neglect | |||
Yes | 29.9 (28.7,31.0) | 34.3 (32.5,36.2) | 26.7 (25.3,28.2) |
No | 67.1 (65.9,68.3) | 62.9 (61.0,64.7) | 70.1 (68.6,71.6) |
Missing | 3.0 (2.6,3.5) | 2.8 (2.2,3.5) | 3.2 (2.7,3.8) |
Physical neglect | |||
Yes | 11.2 (10.5,12.0) | 12.7 (11.5,14.1) | 10.2 (9.2,11.2) |
No | 86.3 (85.4,87.2) | 84.6 (83.1,85.9) | 87.6 (86.4,88.6) |
Missing | 2.4 (2.1,2.9) | 2.7 (2.1,3.4) | 2.3 (1.8,2.8) |
Parents divorced | |||
Yes | 48.7 (47.5,50.0) | 51.6 (49.7,53.6) | 46.6 (45.0,48.3) |
No | 50.3 (49.1,51.6) | 47.2 (45.3,49.2) | 52.6 (50.9,54.2) |
Missing | 0.9 (0.7,1.2) | 1.1 (0.8,1.6) | 0.8 (0.5,1.1) |
Interpersonal violence in family | |||
Yes | 19.4 (18.4,20.4) | 21.9 (20.3,23.5) | 17.6 (16.3,18.8) |
No | 76.5 (75.4,77.5) | 73.2 (71.5,74.9) | 78.8 (77.4,80.1) |
Missing | 4.1 (3.7,4.7) | 4.9 (4.1,5.8) | 3.6 (3.1,4.3) |
Substance use in family | |||
Yes | 25.0 (24.0,26.1) | 27.0 (25.3,28.8) | 23.6 (22.2,25.0) |
No | 70.7 (69.5,71.8) | 67.9 (66.1,69.7) | 72.7 (71.2,74.2) |
Missing | 4.3 (3.8,4.8) | 5.1 (4.3,6.0) | 3.7 (3.1,4.4) |
Mental illness in family | |||
Yes | 50.0 (48.7,51.2) | 52.3 (50.3,54.2) | 48.3 (46.7,50.0) |
No | 46.5 (45.2,47.7) | 43.7 (41.8,45.7) | 48.4 (46.8,50.1) |
Missing | 3.6 (3.1,4.1) | 4.0 (3.3,4.8) | 3.3 (2.7,3.9) |
Family member in prison | |||
Yes | 7.8 (7.1,8.5) | 7.9 (6.9,9.0) | 7.7 (6.9,8.6) |
No | 86.3 (85.4,87.1) | 84.7 (83.3,86.1) | 87.4 (86.3,88.5) |
Missing | 5.9 (5.4,6.6) | 7.4 (6.5,8.5) | 4.9 (4.2,5.6) |
ACE items | Odds Ratio (OR) | 95% CI | p-value |
---|---|---|---|
Emotional abuse | |||
Yes | 1.48 | 1.32, 1.66 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 1.33 | 0.95, 1.85 | 0.09 |
Physical abuse | |||
Yes | 1.56 | 1.35, 1.81 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 1.37 | 1.02, 1.85 | 0.03 |
Sexual abuse | |||
Yes | 1.72 | 1.41, 2.10 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 1.64 | 1.26, 2.12 | < 0.001 |
Emotional neglect | |||
Yes | 1.43 | 1.28, 1.60 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 0.97 | 0.72, 1.31 | 0.8 |
Physical neglect | |||
Yes | 1.30 | 1.11, 1.52 | 0.001 |
No | Ref | Ref | Ref |
Missing | 1.21 | 0.88, 1.68 | 0.2 |
Parents divorced | |||
Yes | 1.23 | 1.11, 1.37 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 1.61 | 0.95, 2.72 | 0.07 |
Interpersonal violence in family | |||
Yes | 1.34 | 1.18, 1.53 | < 0.001 |
No | Ref | Ref | Ref |
Missing | 1.44 | 1.12, 1.86 | 0.004 |
Substance use in family | |||
Yes | 1.23 | 1.09, 1.38 | 0.001 |
No | Ref | Ref | Ref |
Missing | 1.47 | 1.15, 1.89 | 0.002 |
Mental illness in family | |||
Yes | 1.20 | 1.08, 1.33 | 0.001 |
No | Ref | Ref | Ref |
Missing | 1.36 | 1.03, 1.79 | 0.02 |
Incarceration of family member | |||
Yes | 1.05 | 0.87, 1.27 | 0.6 |
No | Ref | Ref | Ref |
Missing | 1.57 | 1.27, 1.95 | < 0.001 |
LASSO logistic regression models
Model | lambda | Number of non-zero coefficients | In-sample deviance ratio | Out of sample deviance ratio |
---|---|---|---|---|
Cross Validated | 0.0107871 | 113 | 0.066 | 0.0246 |
Adaptive | 0.0016839 | 104 | 0.099 | −0.0448 |
Discrimination
Model | Training data | Validation data | |||||
---|---|---|---|---|---|---|---|
AUC | AUC | Sensitivity% | Specificity% | PPV% | NPV% | Overall % | |
Cross Validated | 0.680 | 0.610 | 29.2 | 82.2 | 52.5 | 63.3 | 60.9 |
Adaptive | 0.698 | 0.604 | 37.8 | 74.1 | 49.6 | 63.9 | 59.5 |
Calibration
Model | Predicted probability of ED visit % | Observed ED visit % (95%CI) | Risk stratification capacity N (%) |
---|---|---|---|
Cross Validated | 0–24 | 15.0 (9.2,23.5) | 393 (6.44) |
25–49 | 38.8 (35.9,41.7) | 4330 (70.98) | |
50–74 | 52.5 (47.2,57.8) | 1364 (22.36) | |
75–100 | 50.0 (4.0,96.0) | 13 (0.21) | |
Adaptive | 0–24 | 21.7 (16.6,27.8) | 957 (15.69) |
25–49 | 39.8 (36.5, 43.1) | 3296 (54.03) | |
50–74 | 50.8 (45.8,55.7) | 1592 (26.10) | |
75–100 | 43.1 (32.0, 54.9) | 255 (4.18) |