Caring for Children With Autism in an Emergency Department Setting

Patients with autism spectrum disorder (ASD) and other developmental delays represent a unique patient population. We described a cohort of children with ASD cared for in an emergency department (ED) setting and the specific health care resources used for their care.

This is an observational study of consecutive children (<18 years) with ASD presenting for ED care. Comparisons of interest were evaluated using Wilcoxon rank sum and χ2 tests. Odds ratios (ORs) are reported with 95% confidence intervals (CIs).

There were 238 ED visits over a 9-month period among 175 children. Median age was 9 years, and 62% were male. Reasons for ED visit were medical (51%), psychiatric (18%), injury/assault/trauma (16%), neurological (11%), and procedure related (4%.)Children with psychiatric complaints had longer lengths of stay than those with other chief complaints (P < 0.0001; OR, 5.8; CI, 2.8-11.9) and were more likely to have urine (OR, 8.5; CI, 3.9-18.3) and blood work ordered (OR, 2.5; CI, 1.2-4.9) and less likely to have x-rays ordered (OR, 0.10; CI, 0.02-0.44).Eighteen (8%) children received sedation. None required physical restraint. A total of 30% were admitted to the hospital. Those with psychiatric complaints were more likely to be admitted (54.8% vs 24.5%; OR, 3.7; CI, 1.9-7.4) than those with other chief complaints.

The care for children with ASD varied with age and health care issues. There was a high prevalence of psychiatric complaints, and many of these children were boarded in the ED waiting for an inpatient psychiatric bed. Those with psychiatric complaints were more likely to have multiple tests ordered and were more likely to be admitted.