title: Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions.
abstract: 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.
authors.affiliation: Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, #76, Los Angeles, CA, 90027, USA. adeavenportsaman@chla.usc.edu.|USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA. adeavenportsaman@chla.usc.edu.|USC Keck School of Medicine, Los Angeles, CA, USA. adeavenportsaman@chla.usc.edu.
authors.forename: Alexis
authors.initials: A
authors.lastname: Deavenport-Saman
authors.affiliation: Department of Pediatrics, Harbor-UCLA Medical Center & Los Angeles Biomedical Research Institute, Torrance, CA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, #76, Los Angeles, CA, 90027, USA.|USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.|USC Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, #76, Los Angeles, CA, 90027, USA.|USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.|USC Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Yin
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001321:Autistic Disorder / Q000628:therapy*; D002140:California; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Autism; Children; Emergency department; Hospital admissions; Nonurgent; Overutilization