Data on ECT in Children and Adolescents in the USA 2002-2017
Out on PubMed, in JECT, is this paper:
Trends for Electroconvulsive Therapy Utilization in Children and Adolescents in the United States From 2002 to 2017: A Nationwide Inpatient Sample Analysis.
J ECT. 2021 Feb 19. doi: 10.1097/YCT.0000000000000750. Online ahead of print.PMID: 33625175
The abstract is copied below:
Objectives: Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay.
Methods: Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ≤18 years) undergoing ECT in the United States using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification/Procedure Coding System codes and compared with non-ECT C/A patients with the same primary diagnosis. Baseline clinical characteristics were assessed using descriptive analysis methods. Multilevel regression analysis and trend analysis were performed.
Results: Children and adolescent patients (n = 159,158) receiving (ECT: n = 1870) were more likely to be men (43.3% vs 36.7%) and of White race (58% vs 49%) (P < 0.001). The hospital stay was longer (19 days vs 6 days, P < 0.001) for the ECT group than controls. ECT receiving C/A patients were more likely to have private insurance (72% vs 42%, P < 0.001). African American patients undergoing ECT treatment increased in number over the course of years (2002 to 2017), whereas the privately insured C/A patients receiving ECT decreased over the same period (P < 0.001). There was an upward trend in ECT utilization for small bed size hospitals (P < 0.001). Length of stay for C/A receiving ECT was longer for males (P < 0.001) and patients with nonprivate insurance (p: 0.003).
Conclusions: Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.
and a Table…
This paper provides important data about the use of ECT in patients aged 18 and younger.
It is not clear to me from the methods described in the paper how complete the data are, and what is the approximate total number of C/A patients treated annually with ECT. This is an inpatient dataset; outpatient ECT is not mentioned in the paper.
The study design is focused on comparisons with matched non-ECT C/A inpatients. However, the main conclusions are that ECT is underused in this population and safe.
The mean age of 17 in the sample, is expected, as the typical illnesses for which ECT is indicated often do not present until late adolescence.
The authors note in their discussion both that ECT in this population is highly regulated in some states and that lack of knowledge/familiarity of ECT among child psychiatrists remains an impediment to appropriate prescription of ECT in this population.
It is interesting to speculate what that appropriate amount of ECT would be, and how much additional benefit to public health would accrue from that.
For those interested in the details of this data analysis, a full read will be ~15 minutes.
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