582 - Impact of ADHD Severity and ADHD Medication on Emergency Room Utilization by School-Age Children in the United States

Poster Number: 582

Christian Athanasian, Cohen Children's Medical Center, Port Washington, NY, United States; Nelson Chow, Cohen Children's Medical Center, Lynbrook, NY, United States; Eli Rapoport, New York University Grossman School of Medicine, New York, NY, United States; ANDREW ADESMAN, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, ROSLYN, NY, United States

Background: The core symptoms of ADHD (inattention/hyperactivity/impulsivity) predispose children to accidental injury and increased emergency room utilization (ERU).

Objective: To investigate associations between ADHD diagnosis/severity/medication status and ERU in children ages 6-17.

Design/Methods: Secondary analysis of the 2016-2018 NSCH was performed. A binary measure for ERU was based on whether children visited a hospital ER ≥1 time in the past 12 months. Logistic regressions were used to investigate associations between ERU and current medical diagnosis of ADHD, ADHD severity, and medication status. Regressions were adjusted for key sociodemographic factors, sports team participation, and 10 chronic medical conditions (e.g., asthma) that could increase ERU. Analyses were stratified by age and gender due to age- and gender-related differences in ADHD presentation. Analyses comparing children with ADHD on medication (Med-ADHD) and those not on medication (NoMed-ADHD) adjusted for ADHD severity due to associations between medication and ADHD severity. Analyses accounted for the complex survey design of the NSCH.

Results: Sample characteristics in Table 1. Children with ADHD were overall at 1.42 (95% CI: 1.21, 1.65) times greater odds of ERU compared to children without ADHD, and those with moderate/severe ADHD had even greater ERU (aOR: 1.56, 95% CI: 1.28, 1.90) (Table 2). When comparing ERU between children without ADHD and those with mild ADHD, associations were predominantly among teens (aOR: 1.36, 95% CI: 1.02, 1.80). For girls ages 6-12, those with NoMed-ADHD had higher odds of ERU than those with No-ADHD (all ADHD: aOR = 2.09, 95% CI:1.17, 3.76; moderate/severe ADHD: aOR = 3.84, 95% CI:1.61, 9.15) (Table 3). However, no statistically significant differences in ERU were noted between girls ages 6-12 without ADHD and those with Med-ADHD. Girls ages 6 – 12 on medication for ADHD had reduced ERU (aOR = 0.48, 95% CI: 0.26, 0.91) compared to NoMed ADHD peers; a similar association was noted in the subset with moderate/severe ADHD (aOR = 0.21, 95% CI: 0.08, 0.53). After adjusting for ADHD severity, these associations increased in magnitude slightly. However, similar associations between medication and reduced ERU were not noted for boys or older girls.Conclusion(s): School-age children with moderate/severe ADHD were found to have greater ER utilization, and pediatricians should counsel parents of youth with ADHD regarding accident prevention. Further research is needed to explain why ADHD medication substantially lowered ER utilization among grade-school girls but not boys or older girls.
Table 1. Sample Demographics (2016-18 National Survey of Children’s Health; Ages 6 – 17 years; n=64,423)a Children meeting medical home criteria must have adequate care with regards to personal doctor or nurse, usual source for care, and family-centered care. Children who needed referrals or care coordination must also meet these criteria. Children with a valid, positive response to at least one component and the remainder of the components were missing or legitimately skipped are categorized as having a medical home.

b Emergency Room Utilization (ERU) is defined as ≥1 hospital ER visit in the past 12 months.
Table 2. ADHD Severity and Rates of Emergency Room Utilization (ERU) in Children 6 – 17 Years (2016–2018 National Survey of Children’s Health; n = 64,665)Statistically significant findings are presented in bold text.
aPrevalence figures weighted to be nationally representative
bRegressions were adjusted for household income, highest level of caregiver education, child age, sports team participation in the past 12 months, whether the child has adequate and continuous health insurance, the type of health insurance, whether the child has a medical home, sports team participation, as well as any of the following medical conditions which could increase emergency room utilization: allergies, arthritis, asthma, a blood disorder, a heart condition, severe or frequent headaches, depression, substance use disorder, current diabetes, and frequent/chronic breathing or respiratory problems.

Children with cerebral palsy, cystic fibrosis, Down syndrome, epilepsy, developmental delay, intellectual disability, autism spectrum disorder, uncorrectable vision, serious difficulty walking or climbing stairs, history of birthweight less than 1500 grams, or a history of a past, but not current diagnosis of ADHD were excluded from all analyses.