A Comparison of Medical and Psychobehavioral Emergency Department Visits Made by Adults with Intellectual Disabilities

Abstract

Study Objective. We describe and contrast medical to psychobehavioral emergency visits made by a cohort of adults with intellectual disabilities. Methods. This was a study of 221 patients with intellectual disabilities who visited the emergency department because of a psychobehavioral or medical emergency. Patient profiles are described and logistic regression was used to assess predictors of psychobehavioral emergencies in this group, including age, residence, psychiatric diagnosis, cognitive level, and life events. Results. Ninety-eight individuals had medical emergencies and 123 individuals presented with psychobehavioral emergencies. The most common medical issue was injury and the most common psychobehavioral issue was aggression. In the multivariate analysis, life events (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.10 to 0.75), psychiatric diagnosis (OR 2.35; 95% CI 1.12 to 4.95), and age group (OR 4.97; 95% CI 1.28 to 19.38) were associated with psychobehavioral emergencies. Psychobehavioral emergencies were more likely to result in admission and caregivers reported lower rates of satisfaction with these visits. Conclusion. Emergency departments would benefit from greater understanding of the different types of presentations made by adults with intellectual disabilities, given the unique presentations and outcomes associated with them.

Pain underreporting associated with profound intellectual disability in emergency departments

“…To the best of our knowledge, this is the first study to examine the reasons for hospital ED consultation specifically among persons with PID and to show that in most cases, this is due to somatic problems. This finding is consistent with some previous studies of the broad population of people with ID (McDonald 1985;Whitaker & Read 2006;Findlay et al 2014), although other reports have suggested that psychiatric problems account for a greater proportion of hospital consultations and admissions among people with ID (Balogh et al 2005;Lunsky & Balogh 2010;Lunsky et al 2012c;Tint & Lunsky 2015). In this respect, it is worth noting that in our study group, there were no ED consultations due to attempted suicide or, apparently, to stressful life events, these being circumstances that appear to become more common as intellectual ability increases (Lunsky & Elserafi 2011b;Lunsky et al 2012d).…”

Predictors of emergency service use in adolescents and adults with autism spectrum disorder living with family

“…Similar to previous research on ED use in individuals with intellectual disabilities who may not have ASD, we found the most common medical presentation was injury, and one of the most common mental health presentations was aggression 20. There were situations where emotional distress led to the medical emergency and instances where an unaddressed medical concern presented as self-injury or aggression.…”

“…Similar to the methodology adopted in a previous paper,20 ED descriptions were classified by two independent coders (MP-S, YL) as being caused by a medical or mental health issue; where there were discrepancies, the case was discussed until consensus was reached. The majority of the emergencies were classified as medical in nature (65.4%), with injury accounting for 58.8% of medical ED visits.…”

“…Even though attempts were made to attain a representative sample of this population, it is possible that the individuals in our sample could have more or fewer mental health issues or medical conditions than the general population with ASD. In a brief survey, we could only look at a limited number of variables that the literature5 and our previous research suggest 13 20 would be relevant predictors in this population; however, there may be other predictors of ED visits that were not examined in this study. This being said, the current study has important clinical implications.…”

Hospitalisation rates for children with intellectual disability or autism born in Western Australia 1983–1999: a population-based cohort study

“…Families with children affected by ID and/or ASDs may have particular difficulty in accessing primary and specialist healthcare services, leading to emergency department presentations and hospitalisation rates greater than those not affected by these disorders. A further Canadian study 20 found that admissions to an emergency department for people with ID were more likely to be for a psychobehavioural rather than a medical reason. However, there are less population-based data describing the pattern of hospitalisation among children with ID or ASD.…”