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Factors Related to Hospital Admissions after Emergency Department Visits among

U.S Children with Autism Spectrum Disorder
Wanqing Zhang, PhD, Kathryn L. Williams, MS, Grace Baranek, PhD, Brian Boyd, PhD, Ashley E. Mason, MS
Research Objective

This study investigated child and clinical
characteristics associated with emergency
department (ED) visits and the factors that
resulted in hospital admission among U.S.
children with autism spectrum disorder (ASD).

Study Design

• Secondary data analysis from the
Nationwide Emergency Department Sample
(NEDS)
• Used national estimates of reasons for ED
visits that resulted in hospital admissions, by
o rural-urban residence
o other child/clinical variables
• Applied multivariate regression analysis
o Dependent variable: likelihood of hospital
admissions as a result of ED visits for
children with ASD
o Independent variables at the individuallevel: age, gender, quartile for median
household income, insurance payer
types, chronic condition indicator, and
rural-urban residence
o Independent variables at the hospitallevel: hospital teaching status, hospital
region
Figure 1
Top Five Primary Diagnoses Resulting in a Transfer to
Inpatient Hospitalizations among Children with ASD
5.2%

4.3%
3.8%

3.6%
3.0%

Unspecified episodic Unspecified epilepsy
mood disorder

Pneumonia

Autistic disorder

Dehydration

Population Studied
We used a cross-sectional sample of the NEDS
involving 29,491 ED visits among children aged 3-17 years
with ASD in 2009 and 2010, representing a total of
132,218 pediatric ED visits.
Table 1
Adjusted Odds Ratio for Hospital Admissions following ED Events by Rural-Urban
Residence among Children with ASD
ED Visits
Independent Variables
OR
95% CI
P value
Residence location (Rural vs. Urban)

1.38

(1.15-1.64)

0.0004

Age (13-17 years vs 3-5 years)

1.24

(1.12-1.38)

<.0001

Gender (Female vs. Male)

1.11

(1.02-1.21)

0.0139

Payer (Public vs. Private)
Median household income quartile (Lowest vs.
Highest)

0.77

(0.72-0.83)

0.0489

0.76

(0.69-0.85)

0.0011

Multiple Chronic Conditions (Yes vs. No)

5.95

(5.54-6.39)

<.0001

Hospital Region (South vs. Northeast)

1.09

(0.99-1.19)

0.0737

Hospital Teaching Status (Yes vs. No)

2.02

(1.87-2.18)

<.0001

Key Findings

• Children with an ASD diagnosis were more likely to be
transferred to inpatient hospitalizations than those
without in 2009-2010
• 17.4% hospital admission for ASD group vs. only 4.7% for
non-ASD group (P<.0001)
• Top five primary diagnoses resulting in a transfer to
inpatient hospitalizations among children with ASD
included: unspecified episodic mood disorder ,
unspecified epilepsy, pneumonia, autistic disorder, and
dehydration (see Figure 1)
• After controlling for demographic and hospital/clinical
characteristics, rural children with ASD were about 1.4
times more likely to be hospitalized than their urban
counterparts with ASD
• Children who were older, female, privately insured, with
one or more chronic conditions, in the highest quartile of
median household income, and in teaching hospitals were
more likely to be admitted or transferred as inpatients

Conclusions
• Children with ASD were about 4 times more likely
to be hospitalized after ED events compared to
children without ASD
• Hospitalizations among children with ASD were
associated with age, gender, insurance type,
prevalence of chronic conditions, median
household income level, and hospital teaching
status
• Rural children with ASD had a significantly higher
likelihood of being hospitalized compared to their
urban counterparts
• Both mood and autistic disorders were among the
most common diagnoses related to hospital
admissions after ED events
• Pneumonia and dehydration were frequent but
preventable conditions with higher prevalence
among children with ASD
Figure 2
Characteristics of Hospital Admissions following Pediatric ED Visits
59.0%
53.2%
46.5%

49.5%
46.2%

35.2%

32.5%

35.3%
28.6%
21.9%

20.8%
14.4%

Female

6-12 years old

Public insurance

ASD

South region

Mutiple chronic
conditions

Areas with the
lowest quartile of
median household
income

Non-ASD

Implications for Policy, Delivery or Practice
Making essential mental health services available
and providing adequate access to primary care could
result in a potential avoidance of related inpatient
hospitalizations for children with ASD, especially in
rural areas.
Contact Information
Wanqing Zhang
wanqing_zhang@med.unc.edu
July 16, 2015, 2015 Autism CARES Meeting Bethesda, MD