Examining frequent emergency department use among children and adolescents with autism spectrum disorder

Abstract

We analyze the 2011–2016 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for all emergency department visits by children and adolescents in New York to estimate the association between autism spectrum disorder and frequent emergency department utilization. Our study included 5.9 million individuals with 9.1 million emergency department visits. Of those, 31,682 had autism spectrum disorder (0.5%) accounting for 66,053 (0.7%) emergency department visits. Individuals with autism spectrum disorder had on average 0.6 more emergency department visits per year, were more likely to exhibit frequent emergency department use (⩾4, ⩾6, ⩾8, and ⩾10 emergency department visits/year), and had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. These findings highlight the need for patient and family-centered care interventions and emergency department staff education initiatives. Lay abstract This study used data for 5.9 million individuals with 9.1 million emergency department visits from all hospitals in the state of New York to explore frequent emergency department use between children and adolescents with autism spectrum disorders and those without autism spectrum disorders. We found that children and adolescents with autism spectrum disorders had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. Children and adolescents with autism spectrum disorders were also more likely to utilize emergency departments and to exhibit frequent use. These results emphasize the need for using family-centered care to improve the care experiences of children and youth with autism spectrum disorders and their families. In addition, the education of emergency department staff of processes and practices as it relates to delivery of care and the care experience.

Health service use for young males and females with a mental disorder is higher than their peers in a population-level matched cohort

“…This finding is consistent with studies elsewhere that found young people with ASDs were twice as likely to be hospitalised than the general population [33]. Young people with ASD can experience difficulties in social interactions, sensory processing, behaviour and communication, and often require treatment for co-occurring psychological comorbidities (commonly attention deficit hyperactivity disorder, anxiety and depression) and physical illness [33,34] that can all contribute to their high healthcare needs and utilisation. Children with ASDs aged 1-8 years can experience a higher proportion of comorbidities than their peers and have a higher likelihood of being admitted to hospital and a longer hospital LOS than children without ASD [35].…”

“…Children with ASDs aged 1-8 years can experience a higher proportion of comorbidities than their peers and have a higher likelihood of being admitted to hospital and a longer hospital LOS than children without ASD [35]. Young people with ASDs can also experience difficulties in accessing primary care and report negative experiences with healthcare providers [34,36].…”

Suicide and non-fatal self-injury-related emergency department visits among individuals with autism spectrum disorder

“…Our main independent variable was whether an individual had an ASD diagnosis or not. We used the ICD-9 299.00 and 299.01 (up to October 2015) and ICD-10 F84.0 (November 2015 and beyond) codes across all available diagnosis codes to identify ASD, similar to previous work (Beverly et al, 2021; Hand et al, 2020). We classified individuals as being in the ASD cohort if they had at least one ASD diagnosis across any ED visit throughout the whole study period because ASD is a lifelong condition regardless of when ASD diagnosis was captured.…”

“…The diagnosed prevalence of autism spectrum disorder (ASD) has also increased in the past 20 years from 1 in 150 children in 2000 to 1 in 44 children in 2018 in the United States (Centers for Disease Control and Prevention, 2021). Individuals with ASD are a particularly vulnerable and high-need population, who exhibit higher rates of health care utilization, including up to 30 times higher likelihood of seeking ED care, and medical costs compared to those without ASD (Benevides et al, 2020; Beverly et al, 2021; Kalb et al, 2019; Lytle et al, 2018). ).…”

“…). They have a disproportionately higher burden of mental health, psychiatric, physical, and social functioning conditions, lower quality of life, worse health outcomes, and higher mortality rates compared to those without ASD (Beverly et al, 2021; Cassidy et al, 2018; Kirby et al, 2019; Lai et al, 2019; Vohra et al, 2016). Notably, almost 70% of individuals with ASD have at least one mental health condition and about 50% are diagnosed with multiple mental health conditions (Lai et al, 2014).…”