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.
J Dev Behav Pediatr. 2019 Apr;40(3):170-175. doi: 10.1097/DBP.0000000000000650.
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.
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.
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).
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.
本研究的主要目的是描述在急诊科（ED）诊断为阑尾炎或长骨骨折的神经典型（NT）个体和自闭症谱系障碍（ASD）个体之间的镇痛药物管理。次要目的是比较两组中作为延迟诊断替代指标的复杂阑尾炎发生率。
这是一项使用儿科健康信息系统数据库的回顾性队列研究。研究参与者为年龄在 6 至 18 岁之间的 ASD 儿童，他们在 2004 年至 2015 年期间因阑尾炎或骨折在 ED 就诊，且与 NT 儿童在人口统计学上相似。排除患有发育障碍和/或复杂慢性病的儿童。使用粗化精确匹配和逻辑回归来研究 ASD 状态与阿片类药物和非阿片类药物药物使用之间的关联。在匹配之前，比较 ASD 儿童和 NT 儿童之间复杂阑尾炎的发生率。
在 2004 年至 2015 年间，共确定了 126412 例阑尾炎和 392151 例长骨骨折儿童。其中，889 例儿童被诊断为 ASD，并与 35672 例 NT 对照组阑尾炎患者相匹配。此外，2117 例 ASD 儿童与 200635 例 NT 对照组长骨骨折儿童相匹配。未发现两组之间阿片类药物或非甾体抗炎药的使用存在显著差异。然而，与 NT 对照组相比，更多的 ASD 儿童表现出复杂的阑尾炎（分别为 37.1%和 29.9%；p<0.001）。
ASD 人群和 NT 同龄人之间的镇痛药物使用无显著差异。ASD 儿童复杂阑尾炎的发生率较高，这可能表明他们获得医疗服务的机会有限，或者提供者在评估该患者人群时存在困难。
