Prospective Study of Families of Children with Autism Spectrum Disorder in the Emergency Department
Objectives: To understand the differences in ED utilization among children with ASD and other developmental disabilities (DD) compared to typically developing children.
Methods: A prospective cohort study was implemented in the ED at a level 1 pediatric trauma center in 2013. Children with ASD or other DD and those who were typically developing were followed as they were admitted in the ED. Main outcomes were the number of visits per child and whether hospitalization occurred.
Results: There were 353 children, 0-20 years of age, who visited the ED 1101 times; of these, the rate of visits was 4.7 among children with ASD or another DD, compared to 2.8 among typically developing children. The most common presenting “chief complaint” expressed by parents were similar among children with ASD or another DD and among typically developing children: trauma, infection, and abdominal pain. There were a total of 51 hospitalizations: 20.9% among children with ASD or another DD and 4.7% among typically developing children. The majority of children in all groups were covered by Medicaid and were of Hispanic descent. In all groups, having either ASD or another DD, being Hispanic (β=0.13 t(280) = 2.1, p<0.05), and having a lower age (β=-0.13, t(280) = -2.31, p<0.05), significantly predicted the number of visits. There were no significant differences in odds of hospitalization between children who had ASD or another DD and typically developing children.
Conclusions: High demand for ED care contributes to overcrowding, increased costs and fragmentation of care. Most families visited the ED for the same reasons. Children with ASD or another DD utilized the ED more frequently than typically developing children, however, they did not have greater odds of hospitalization. More research is needed to explore factors related to potential ED utilization, particularly among children with ASD or another DD.