title: Psychiatric-related emergency department visits among children with an autism spectrum disorder.
abstract: OBJECTIVE
  This study aimed to examine the prevalence and characteristics of psychiatry-related emergency department (ED) visits among children with an autism spectrum disorder (ASD), including the specific reason for visit, as well as the influence of insurance type.
  
  
  METHODS
  Data used for this cross-sectional, observational study were obtained from the 2008 National Emergency Department Sample, the largest all-payer ED database in the United States. Psychiatry-related visits to the ED among children with ASD were identified using International Classification of Diseases, Ninth Revision, billing codes. A total of 3,974,332 visits (unweighted) were present for youth 3-17 years, of which 13,191 involved a child with ASD.
  
  
  RESULTS
  Thirteen percent of visits among children with ASD were due to a psychiatric problem, as compared with 2% of all visits by youths without ASD. Results from the multivariate analyses revealed that the likelihood for a psychiatric ED visit was increased 9-fold (odds ratio [OR], 9.13; 95% confidence interval [CI], 8.61-9.70) among pediatric ASD visits, compared with non-ASD visits. Children with ASD who were covered by private insurance, compared with those with medical assistance, were at even greater risk for a psychiatric ED visit (OR, 1.58; 95% CI, 1.53-1.63). Visits among children with ASD were more likely to be due to externalizing (OR, 1.62; 95% CI, 1.44-1.83) and psychotic (OR, 1.93; 95% CI, 1.58-2.35) disorders compared with visits among non-ASD children.
  
  
  CONCLUSIONS
  This study highlights the need for improving community-based psychiatric systems of care for youths with ASD to divert psychiatry-related ED visits, particularly for those children with private insurance.
authors.affiliation: Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD 21211, USA. kalb@kennedykrieger.org
authors.forename: Luther G
authors.initials: LG
authors.lastname: Kalb
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.forename: Brian
authors.initials: B
authors.lastname: Freedman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zablotsky
authors.forename: Roma
authors.initials: R
authors.lastname: Vasa
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000600:supply & distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D007343:Insurance Carriers / Q000191:economics / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology