Written by Kimiko Dunbar
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For patients with somatic symptom and related disorders, lab tests and subspecialty consultation increases length of stay.
How much is too much?
This retrospective study analyzed 173 children (6–18 years) hospitalized with somatic symptom and related disorders (SSRDs) at a tertiary care hospital. More than half of the patients had a previously diagnosed mental health disorder (53.8%), most commonly anxiety or depression. There were many more female than male children included in the study; boys with SSRDs were generally younger than girls. Neurologic symptoms were most common (63%), with functional neurologic disorder being the predominant diagnosis (38%). Resource utilization was high, with a median of 9 laboratory tests and 72% receiving specialist consultations. Most patients had at least 1 imaging study performed (69%). Length of stay range was variable (0.5 – 14.2 days) and correlated with the number of consults and lab tests. Patients with psychogenic nonepileptic seizures (PNES) had lower resource utilization and shorter LOS than patients with other somatic disorders. In contrast to prior studies, sociodemographic factors were not associated with significant differences in work-up or management of SSRDs. This study was limited by single center design. Standardized clinical pathways may reduce unnecessary testing and optimize management.
How will this change my practice?
I would really love to decrease length of stay and diagnostic work-up for patients with SSRDs. While increased testing is associated with increased length of stay, it’s hard to know the extent to which testing and consultation were required in order to make a definitive diagnosis of SSRD. While SSRDs are very common, no one wants to inappropriately label a patient as having a somatic or functional presentation until they are sure. Ultimately, I think this study calls for a streamlined approach to patients presenting with possible SSRD to minimize unnecessary testing, while also allowing for safe exclusion of alternate diagnoses.
Source
Characteristics and Resource Utilization of Hospitalized Children With Somatic Symptoms. Hosp Pediatr. 2025 Jan 1;15(1):66-73. doi: 10.1542/hpeds.2024-007847. PMID: 39660899
