Presenter Profile
Ashley Blanchard, MD, MS
Columbia University Medical Center
ab3923@cumc.columbia.edu
Dr. Ashley Blanchard is a pediatric emergency room physician and Assistant Professor at Columbia University Irving Medical Center. She completed her residency in pediatrics and fellowship in pediatric emergency medicine at Morgan Stanley Children’s Hospital at Columbia University Irving Medical Center. During her clinical training she obtained a Masters in Biostatistics and Patient Oriented Research at Columbia Mailman school of Public Health. Her research focuses on prevention of pediatric injuries and deaths within the high-risk populations she treats in the emergency room. She has a specific interest in injury prevention interventions targeted to unique populations with differential risk of injury (such as children and adults with autism). Her current work aims to describe epidemiologic trends in injuries among children with autism and the use of mobile health technology to reduce adolescent access to lethal means and prevent adolescent suicide.
Presentations
Association of Autism Spectrum Disorder and Common Co-Occurring Conditions with Suffocation
Ashley Blanchard, MD, MS
Carolyn DiGuiseppi, MD, PhD
Caleb Ing, MD, MS
Guohua Li, DrPH
People with autism spectrum disorder (ASD) are at heightened risk of injury-related death and specific injuries, such as drowning and self-injury. As ASD prevalence rises, epidemiologic data describing specific injuries, such as suffocation, are essential for prevention efforts. We aimed to describe the excess risk of suffocation associated with ASD and common co-occurring diagnoses among people treated in United States (US) emergency departments (EDs).
Using a repeated cross-sectional study design, we analyzed data from the 2016-2020 Nationwide Emergency Department Sample (NEDS), the largest US all-payer ED visit claims database. Children ? 1 years and adults diagnosed with ASD and treated in EDs were identified using ICD-10-CM code F84.0. Intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and Alzheimer's disease and related dementia (ADRD) were similarly identified using relevant ICD-10-CM codes. ED visits for suffocation were identified using the ICD–10–CM external cause-of-injury matrix. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of suffocation-related ED visits in persons with and without ASD, ID, ADHD, and ADRD. Each model was adjusted for the other conditions, age, sex, urbanicity, and payor.
The 2016-2021 NEDS recorded a weighted total of 803,777,608 ED visits, of which 1,012,210 (0.13%) were related to suffocation. Suffocation accounted for 0.35% of ED visits in patients with ASD, 0.67% of ED visits in patients with a diagnosis of ID, 0.07% of ED visits in patients with a diagnosis of ADHD, and 0.34% of ED visits in patients with a diagnosis of ADRD. Patients with ASD had a 75% increased odds of suffocation (aOR = 1.75; 95% CI: 1.65, 1.86), patients with ID a more than six-fold increased odds of suffocation (aOR = 6.56; 95% CI: 6.2, 6.94), patients with ADHD a 44% increased odds of suffocation (aOR = 1.44; 95% CI: 1.35, 1.53), and patients with ADRD a 106% increased odds of suffocation (aOR = 2.06; 95% CI: 2.01, 2.12). Across the lifespan suffocation accounted for a larger proportion of ED visits among patients with ASD than those without ASD.
Children and adults with ASD have an increased odds of ED-treated suffocation. ID, ADHD, and ADRD common co-occurring diagnoses with ASD across the lifespan, are also associated with increased odds of ED-treated suffocation. Further understanding of environmental circumstances and unique factors that may increase risk of suffocation in people with ASD is needed.
Learning objectives
1) Children and adults with autism have an increased odd of ED-treated suffocation.
2) Review the risk of suffocation in children with autism among various age groups.
3) Understand risk factors that may predispose children with autism to suffocation.