Emergency Hold Use in Youth With Mental Health Concerns Presenting to the Emergency Department

OBJECTIVE Emergency holds are commonly used in mental health crisis care, yet pediatric-specific data on their application and downstream consequences for emergency department (ED) care remain limited. We sought to describe sociodemographic and clinical factors associated with emergency hold status, including their relation to ED physical restraint use, among youth presenting to the ED for mental or behavioral health (MBH) concerns. METHODS We conducted a retrospective cross-sectional study of patients aged 6 to 18 years presenting with an MBH concern to an urban, tertiary pediatric ED from January 2019 through December 2024 using multivariable generalized estimating equation models to identify factors associated with emergency holds and physical restraint use. RESULTS Of the 14 883 MBH ED visits, 2219 (15%) arrived under emergency hold; 87% identified as Black, 85% were publicly insured, 20% arrived by mobile crisis unit, and 64% arrived with law enforcement. Emergency holds increased year over year during the study period and were associated with multiple sociodemographic and clinical factors, including Black race, male sex, any prior MBH ED visits in the past 12 months, longer ED stay, and physical restraint use. Physical restraint use also increased year over year and was associated with emergency hold status; however, mobile crisis involvement was not associated with physical restraint use. CONCLUSIONS Emergency holds in this single-center cohort were frequent, increased over time, and were associated with physical restraint use and longer ED stays. Mobile crisis may mitigate restraint use; further study is needed to clarify its impact. Strategies to reduce restrictive interventions warrant further evaluation.