Spectrum Disorder Admitted to
Inpatient Pediatric Medical Units
Abstract:
OBJECTIVES: Our goals for this study were to characterize the frequency of agitation in patients
with autism spectrum disorder (ASD) admitted to an inpatient pediatric medical unit and to
identify risk factors associated with agitation.
METHODS: Through a retrospective chart review, we identified every patient between 8 and
19 years of age with a documented ASD diagnosis admitted to a pediatric medical unit over
a 5-year period. We performed a detailed review of each admission, with a focus on factors
hypothesized to be correlated with risk of agitation.
RESULTS: One or more episode of agitation occurred during 37 (12.4%) of the 299 admissions
and for 31 (18.5%) of the 168 patients who met inclusion criteria. History of agitation (risk
ratio 21.9 [95% confidence interval 5.4–88.3] for history of severe agitation; P , .001) and
documented sensory sensitivities (risk ratio 2.3 [95% confidence interval 1.3–3.8]; P , .001)
were associated with a significantly increased risk of agitation during admission. History of
past psychiatric admissions was associated with increased risk before, but not after,
controlling for history of agitation and sensory sensitivities. Psychiatric comorbidity,
intellectual disability, acute pain on admission, number of preadmission psychotropic
medications, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ASD
diagnosis, age, and sex were not significantly associated with increased risk.
CONCLUSIONS: Hospitalization can be challenging for patients with ASD. A subset of these patients
experience episodes of agitation during admission, posing a safety risk to patients and staff.
Characterizing risk factors associated with these behaviors may allow for identification of
at-risk patients and guide targeted intervention to prevent negative behavioral outcomes