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Disparities in Care

Do Children with Autism Spectrum Disorder Experience Differential Medication Receipt In The Emergency Department?

Friedlaender, Eron, MD, MPH*; Griffis, Heather, PhD; Faerber, Jennifer, PhD‡,§; Quarshie, William, MS; Ely, Beth, RN, PhD

Journal of Developmental & Behavioral Pediatrics: April 2019 - Volume 40 - Issue 3 - p 170–175
doi: 10.1097/DBP.0000000000000650
Original Articles

Objective: The primary objective of this study was to describe analgesia administration between neurotypical (NT) individuals and those with autism spectrum disorder (ASD) diagnosed with appendicitis or long bone fractures in the emergency department (ED). A secondary objective was to compare the rates of complicated appendicitis as a proxy for delayed diagnosis between the groups.

Methods: This is a retrospective cohort study using the Pediatric Health Information System database. Study participants were children aged 6 to 18 years with ASD and with an ED visit for appendicitis or fracture between 2004 and 2015 who were matched to demographically similar NT children. Children with a developmental disorder and/or complex chronic condition were excluded. Coarsened exact matching and logistic regression were used to investigate the association between ASD status and opioid and non-opioid medication receipt. Comparison of the rates of complicated appendicitis in children with ASD and NT children was conducted before matching.

Results: From 2004 to 2015, 126,412 children with appendicitis and 392,151 children with long bone fractures were identified. Of these, 889 children had a diagnosis of ASD and were matched to 35,672 NT controls with appendicitis. In addition, 2117 children with ASD were matched to 200,635 NT controls with long bone fractures. Receipt of opioids or nonsteroidal anti-inflammatory drugs was not found to be significantly different between the 2 groups. However, a larger proportion of children with ASD presented with complicated appendicitis compared with NT controls (37.1% vs 29.9%, respectively; p < 0.001).

Conclusion: Receipt of analgesia did not differ significantly between populations of ASD and NT peers. Children with ASD have increased rates of complex appendicitis, possibly suggesting limited access to care or provider difficulty in evaluating this patient population.

*Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;

Healthcare Analytics Unit at the Center for Pediatric Clinical Effectiveness and PolicyLab at the Children's Hospital of Philadelphia, Philadelphia, PA;

Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;

§Department of Biostatistics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;

Nurse Scientist Consultant, Ambler, PA.

Address for reprints: Eron Friedlaender, MD, MPH, Division of Emergency Medicine, Children's Hospital of Philadelphia, Colket Translational Research Building, 9th Floor, 3501 Civic Center Boulevard, Philadelphia, PA 19104; e-mail:

The MAYDAY Fund generously supported this work without involvement in the study design, collection, analysis, or interpretation of findings; the writing of the manuscript; or the decision to submit for publication.

Disclosure: The authors declare no conflicts of interest.

Received June 29, 2018

Accepted December 18, 2018

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