Objective: To examine the epidemiological features of emergency department (ED) visits related to unintentional drowning in children with autism spectrum disorder (ASD).

Methods: The cross-sectional study was an analysis of the National Emergency Department Sample (NEDS) data from 2016 to 2018. Patients aged 1-24 years with a diagnosis of ASD were identified based on the ICD-CM-10 code F84.0. ED visits for unintentional drowning (ICD-CM-10 codes: W65 to W74) were compared between children with and without ASD diagnosis according to age, sex, psychiatric comorbidity, and drowning circumstances. Survey weighted multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of unintentional drowning associated with ASD.

Results: During the study period, the NEDS recorded a total of 53 ED visits for unintentional drowning by children aged 1-24 years with a diagnosis of ASD. Over half of these drowning cases were among children under the age of ten (56.6%, n=30). Based on the analysis of accidental drowning circumstances, the most common site of drowning was in the swimming pool (45.3%, n=24), followed by bathtub (9.4%, n=5) and natural water (9.4%, n=5). The adjusted OR of unintentional drowning associated with ASD was 2.61 (95% CI: 1.958, 3.481).

Conclusion: Children with ASD are at significantly increased risk of ED-treated unintentional drowning, particularly when they are under 10 years of age and in the swimming pool or bathtub.

Background

The World Health Organization has reported that submersion injuries are the third most common cause of death due to unintentional injury in the world, yet, remains a challenge to address. Greater detail in the rates, risk factors, and healthcare associated costs of submersion injuries could be instrumental in demonstrating the need for further funding and intervention.

Methods

The study was a cross-sectional analysis of a nationally representative dataset of inpatient and emergency department (ED) encounter between 2006 and 2015 in the United States (US). Healthcare utilization costs were provided within the datasets and adjusted to reflect actual charges and provider fees using a validated conversion ratio. Lastly, the final cost values were adjusted to the 2020 US dollar (USD) and summarized using a log adjusted mean.

Results

On average, there were 11,873 submersion injuries per year that presented to the ED in the US. Resulting in approximately 9 out of every 100,000 ED visits being related to a submersion injury. 6.5% died in the ED, 24.2% were admitted, and 69.3% were discharged from the ED. In total, annual costs in the US for ED care is approximately $12.5 million, inpatient care is approximately $27.5 million, and total healthcare costs exceeds $40 million, USD 2020.

Conclusions

While this only represents a fraction of the total cost associated with submersion injuries, it remains substantial and unchanged over the 10 year study period. Certain demographic groups showed higher rates of injury and disease burden, thus bearing a greater amount of the cost.

Unintentional injuries are the leading cause of deaths at ages 1-44. Etiological investigation of injuries can guide prevention. The codes for supplementary factors related to causes of morbidity (Y90-Y99) in the International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10-CM) identify environmental events and circumstances associated with the cause of injury, notably activity and place of occurrence. We assessed the use of these codes for hospital-admitted and emergency department (ED) injury patients overall and at ages 0-19. We analyzed 2017-2018 data from the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS), to assess code presence and usability. The supplementary codes were more commonly coded in ED than in hospital admissions data (42% for admissions and 47% for ED cases overall, 37% and 50% at ages 0-19). Place of occurrence codes were the most commonly coded (38% for admissions and 39% for ED cases overall, 33% and 38% at ages 0-19). Unfortunately, one-quarter of these codes had other unknown/not applicable or other/not elsewhere specified. One-fifth were unspecified place in a private residence. Activity codes were presented in 13% of admitted and 23% of ED cases, almost always in cases that included place of occurrence codes. Supplementary factors that potentially could guide prevention work are coded insufficiently to be very reliable, albeit more often than external cause codes were coded before becoming mandatory in most states. Frequent use of unspecified codes suggests some facilities are coding almost all cases.

Background: Self-harm among youth in the US is a public health problem with severe consequences, including intentional and unintentional fatalities. Stress related to the COVID-19 pandemic may be attributed to changes in self-harm behaviors. This study sought to investigate self-harm in youth before and during the COVID-19 pandemic by demographic and geographic characteristics.

Methods: Using data from the Connecticut Injury Surveillance System, we will examine emergency department (ED) discharges for self-harm in youth aged 10-18 years in the pre-COVID (January 1, 2019-January 31, 2020) and COVID (February 1, 2020- December 31, 2020) periods. ICD-10-CM codes X71-X83 were used to identify visits for self-harm. We mapped the frequencies of ED visits for self-harm cases by Connecticut zip code using ggplot2 in RStudio. A chi square test and paired t-test will be used to assess the changes in ED visits for self-harm by time period and geographic areas.

Anticipated Results: Patients in urbanized areas will show higher rates of self-harm than patients in rural regions, and; the number of self harm cases reported will decrease during the COVID period.

Conclusion: Fear of contracting the virus when compared to the pre-COVID period may influence health seeking behaviors in self-harming adolescents. Further research is needed to explore self-harm cases in primary care, community health, or telehealth settings during extended periods of isolation and national crisis. Increased tele-health practices should be explored to ensure accessible mental healthcare is available for those who cannot leave their homes during future periods of long-term isolation.