Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions

Matern Child Health J. 2016 Feb;20(2):306-14. doi: 10.1007/s10995-015-1830-y.


Background: Children with autism spectrum disorders (ASD) are more likely to have difficulties accessing health care compared to other children with special health care needs. National data based on parent report indicate that children with ASD are overutilizing emergency department (ED) services, but data on actual ED use has been limited to children with psychiatric diagnoses. This study examined factors associated with ED utilization (rate, urgency, and hospital admissions) among children with ASD compared to those without ASD.

Methods: Data from an urban, tertiary children's hospital level 1 trauma center were examined retrospectively 2006-2009. Anderson's model of health services utilization served as the study framework. The NYU ED algorithm was used to predict nonurgent visits. Multivariate linear and logistic regression analyses were performed on the rate, urgency, and subsequent hospital admissions of these ED visits.

Results: There were 115,443 children 2-21 years old, accounting for a total of 157,902 visits. The top three reasons for visiting the ED for children with and without ASD were acute upper respiratory infections, viral infections and otitis media. Children with ASD had on average 0.26 more ED visits annually than children without ASD (p < 0.01) and were 2.6 % points more likely to have nonurgent visits; p < 0.01). Their visits were also less likely to result in hospital admissions (OR 0. 61; p < 0.01).

Conclusions: Examination of predisposing, enabling, and reinforcing factors suggest that children with ASD were more likely to visit the ED and for nonurgent reasons.

Keywords: Autism; Children; Emergency department; Hospital admissions; Nonurgent; Overutilization.

MeSH terms

  • Adolescent
  • Age Distribution
  • Autistic Disorder / therapy*
  • California
  • Child
  • Child, Preschool
  • Emergencies / epidemiology
  • Emergency Medical Services / economics
  • Emergency Medical Services / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data
  • Emergency Services, Psychiatric / statistics & numerical data
  • Female
  • Health Expenditures*
  • Health Services Misuse / economics
  • Health Services Misuse / statistics & numerical data*
  • Health Surveys
  • Humans
  • Infant
  • Insurance, Health* / economics
  • Insurance, Health* / statistics & numerical data
  • Male
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Patient Admission / statistics & numerical data*
  • Retrospective Studies
  • Young Adult