Vulnerabilities associated with physical health conditions for emergency department utilization in adolescents with autism spectrum disorder

Background: Adolescents with Autism Spectrum Disorder (ASD) have been found to have higher emergency department (ED) utilization due to psychiatric crisis compared to adolescents without ASD. However, little attention has been given to identification of physical health risk factors specifically associated with ED utilization in this population. Method: This was a retrospective longitudinal study using the 2005–2014 MarketScan® claims database. We extracted a cohort of subjects with ASD, aged 12–21 and having a minimum of two full consecutive calendar years of enrollment. The outcome variable was a binary indictor of ED utilization during a calendar year. In addition to the univariate association analysis, we performed a multivariable logistic regression analysis to evaluate the independent effects of prior physical health conditions while adjusting for mental health conditions and other potential confounders. Results: Our study included 181,686 person-years of data from 63,886 subjects with ASD. The multivariable regression analysis showed that prior physical health conditions were associated with elevated risk for ED visit. In particular, prior injuries posted the highest risk of ED utilization (adjusted odds ratio [aOR]: 2.54; 95 % confidence interval [CI]: 2.35–2.75). Epilepsy and gastrointestinal (GI) problems were also found to be strongly associated with the increased ED utilization (epilepsy: 2.34; 2.10–2.60; GI problems: 2.16; 1.97–2.37). Conclusions: This study indicated that individuals with co-occurring physical health conditions appear to be at a high risk for ED visit in adolescents with ASD. These identified risk factors may serve as effective intervention points to refine current standards of care for this historically under-served population.