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Prolonged Emergency Department Stays for Patients With Autism and Acute Mental Health Concerns
Joanna S Cohen1, Priyal Patel2, Amanda Finney1
1Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Insights
Children with autism spectrum disorder (ASD) experience longer emergency department (ED) stays and boarding times during mental health crises. This highlights critical access issues for these children requiring hospitalization.
Area of Science:
- Pediatric Emergency Medicine
- Child Psychiatry
- Autism Spectrum Disorder Research
Background:
- Children with autism spectrum disorders (ASD) frequently experience mental health emergencies.
- Limited access to psychiatric units results in prolonged stays in emergency departments (EDs).
Purpose of the Study:
- To investigate if autism is an independent risk factor for extended ED stays.
- To determine if autism influences ED psychiatric boarding durations.
- To assess the impact of autism on prolonged ED boarding for children requiring hospitalization for mental health concerns.
Main Methods:
- Retrospective cohort study utilizing the PECARN Registry Dataset (2016-2021).
- Included ED encounters for patients aged 5-18 with primary mental health diagnoses requiring admission.
- Analyzed ED length of stay, focusing on autism as the exposure variable, controlling for age, sex, race/ethnicity, and insurance.
Main Results:
- The study included 73,624 ED visits (7511 with autism).
- Autism was associated with increased odds of prolonged ED stay (aOR 1.26).
- Patients with autism had higher odds of ED boarding (aOR 1.68) and prolonged boarding >48 hours (aOR 3.91) and >72 hours (aOR 3.91) after adjustment.
Conclusions:
- Autism is confirmed as an independent risk factor for prolonged ED stays.
- Autism significantly increases the likelihood of ED boarding and prolonged boarding times.
- Findings underscore the need for improved ED care pathways for children with ASD during mental health crises.
Background:
Children with autism spectrum disorders face high rates of mental health emergencies often requiring hospitalization, but limited psychiatric unit access often leaves them waiting in emergency departments (EDs).
Objective:
To determine if autism is an independent risk factor for prolonged emergency department (ED) stays (>90%), ED psychiatric boarding (>24 hours), and prolonged ED boarding (>48 or 72 hours) for children with mental health concerns requiring hospitalization METHODS: This was a retrospective cohort study using the PECARN Registry Dataset from 2016 through 2021. All ED encounters for patients ages 5 to 18 years of age requiring admission for a primary mental health diagnosis were included. The primary outcome was ED length of stay, the primary exposure variable was autism, and potential confounding variables were age, sex, race/ethnicity, and insurance status.
Results:
A total of 73,624 ED visits were included, 66,113 visits without autism and 7511 with autism. When adjusted for age, sex, race and insurance, admitted patients with autism had higher odds of a prolonged ED stay (aOR 1.26, 95% CI 1.15-1.38), ED boarding (aOR 1.68, 95% CI 1.41-2.00), and prolonged ED boarding > 48 hours (aOR 3.91, 95% CI 2.62-5.84) and > 72 hours (aOR 3.91, 95% CI 2.14-7.14).
Conclusion:
Autism is an independent risk factor for having a prolonged ED stay, for boarding in the ED, and for prolonged ED boarding when presenting to the ED with a mental health crisis that requires hospitalization.
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