Psychiatric Boarding Hospitalizations for Children With Autism in a Children's Hospital System

Children with autism spectrum disorder (ASD) are more likely to be hospitalized for psychiatric disorders than their neurotypical peers. Hospitalized children with ASD are at higher risk of experiencing agitation and physical restraint use. We aimed to compare the demographics and outcomes of psychiatric boarding hospitalizations for children with ASD between 1 main campus with enhanced psychiatric resources and 2 community campuses with limited psychiatric resources in the same children's hospital system.

We conducted a retrospective cohort study of children with ASD hospitalized for psychiatric boarding and referred to psychiatry and psychology services across a children's hospital system between October 2020 and September 2024. Patients' ASD diagnosis and medical clearance were verified during psychology evaluation.

During the 4-year period, 174 children with ASD experienced 347 psychiatric boarding hospitalizations across the hospital system, of which 77% were at the main campus and 23% at community campuses. The patients' median age was 13 years (IQR, 11-16) and 72% were male. The median length of stay was 6 days (IQR, 4-11), with 80% discharged to an outpatient setting. Staff injury incidence was significantly lower at the main campus than at community campuses (22% vs 42%; P = .02), but physical restraint incidence did not differ significantly between campuses.

Staff injuries were significantly less frequent during psychiatric boarding hospitalizations for children with ASD at the main campus with enhanced resources, but physical restraint use was not. Future research should further examine the relationship between ASD care models and safety outcomes across diverse pediatric inpatient settings.