A Profile on Hospitalization Subsequent to ED Visits in Adolescents with Autism Spectrum Disorders

Background: The prevalence of ASD began to increase dramatically about a decade ago, and now the first wave of these children has approached adolescence and early adulthood. While early diagnosis and intervention have been the focus of the scientific and clinical communities, the population of adolescents with ASD has not received the same attention. Although various ASD-related healthcare services have been designed to better serve this population, it is relatively unknown how well they are being served.

Objectives:  In this study, we use a large, national healthcare claims database to compare the healthcare utilization history (in-/out-patient medical records) of adolescents with and without ASD, with a focus on hospitalization due to emergency department visits. The goal of this study is to provide an assessment on patterns of hospitalizations subsequent to ED visits as an indicator of the physical and mental health well-being of adolescents with ASD.

Methods:  Using the 2005-2013 MarketScan® Commercial Claims and Encounters database, we identified cohorts of patients who had at least one ED visit during any of those years. We constructed a sub-cohort of children with at least two separate diagnoses of ASD (ICD 9 codes 299.0x and 299.8x) and a sub-cohort of children without ASD. We also broke down the entire cohort into annual cohorts. In each of the annual cohorts as well as in the combined cohort, we described the proportion of patients whose ED visits resulted in subsequent hospitalizations. We also compared the hospital length of stay among ASD vs. non-ASD patients.

Results:  As observed in Figure 1, a consistently higher proportion of adolescents with ASD had an ED visit leading to hospitalization than adolescents without ASD. In particular, the odds ratio (OR) of admission to hospital after ED among ASD and non-ASD patients was 4.226, with a 95% confidence interval (CI) of 4.047 – 4.412]. Older adolescents (28.22% ASD vs. 8.13% non-ASD for age 18-21; 27.39% ASD vs. 8.15% non-ASD for age 15-17) were more likely to be hospitalized after an ED visit than younger adolescents (22.92% ASD vs. 6.26% non-ASD for age 12-14). While males and females were equally likely to be hospitalized after ED visits among adolescents without ASD (7.61% male vs. 7.69% female), female adolescents with ASD were more likely than males (28.02% vs. 25.13%) to be admitted to the hospital after an ED visit. Adolescents with ASD were also more likely to stay in the hospital longer (average days of hospitalization: 6.38 ± 8.10) than adolescents without ASD (3.97 ± 5.65). Adolescents with ASD were more likely to be hospitalized 3 days or longer (70.76% vs. 51.13) and 7 days or longer (31.55% vs. 15.13%) than adolescents without ASD.

Conclusions:  Our study showed a disconcertingly high proportion of adolescents with ASD who had hospitalizations subsequent to emergency department visits over the past decade or so. Furthermore, adolescents with ASD who were hospitalized had longer lengths of stay than adolescents without ASD, suggesting a vulnerability of having physical injuries and/or medical complications, potentially due to an ASD-related mental health crisis.