P2.164: Prolonged Emergency Department Stays for Patients with Autism and Acute Mental Health Concerns

Background: Children with autism spectrum disorders have high rates of psychiatric hospitalization. The aim of this study was to determine if autism is an independent risk factor for prolonged ED stays, ED boarding, and prolonged ED boarding for children with mental health concerns requiring hospitalization.

Methods: This was a retrospective cohort study using the PECARN Public Use Dataset for the years 2016 through 2021. All ED encounters for patients ages 5 to 18 years of age with a primary mental health diagnosis and a disposition of admission were included. The primary outcome was ED length of stay and the primary exposure variable was autism. We included the following potential confounding variables in the analysis: age, sex, race/ ethnicity.

Results: A total of 73, 624 ED visits were included, 66,113 visits without autism and 7511 with autism. The mean ED length of stay was 328 minutes (IQR 243, 451) with patients with ASD staying on average 14 minutes longer than those without ASD (p <.001). When adjusted for age, sex, race, and ethnicity, admitted patients with autism had higher odds of a prolonged ED stay (aOR 1.231, 95% CI 1.42, 1.328), ED boarding (aOR 1.683, 95% CI 1.414, 2.002) , and prolonged ED boarding > 48 hours (aOR 3.995, 95% CI 1.905, 5.822) and > 72 hours (aOR 4.015, 95% CI 2.198, 7.334) than those without autism.

Conclusion: Among pediatric ED visits for mental health concerns requiring hospitalization, autism is associated with a prolonged ED stay, ED boarding, and prolonged ED boarding.