15 Utilization of Emergency Department Services among Children with Neurodevelopmental Diagnoses: A Scoping Review
Bibliographic record
Abstract
Abstract Background Children with neurodevelopmental diagnoses (NDDs) have complex health system needs which are often not adequately addressed due to the lack of suitable community services. As a result, these children use comparatively more healthcare resources and caregivers have no choice but to rely on emergency departments (EDs).The chaotic ED environment can be particularly challenging for children with sensory, communication, and behavioural issues, leading to increased stress and higher instances of sedation and restraint. A significant gap in the knowledge, experience, and training of ED staff regarding the care of neurodivergent patients only further exacerbates barriers to accessing quality care. Existing reviews tend to focus on a single NDD, often overlooking the shared features and frequent co-occurrence of these conditions. Objectives This scoping review aims to examine the extent of the literature for various NDDs related to ED utilization, identify common behavioural presentations to the ED, and highlight challenges faced by children with NDDs in this setting. Design/Methods The review was registered on the Open Science Framework. A systematic search was conducted across multiple databases to identify relevant studies (Embase, PSYCHINFO, MEDLINE, Web of Science, and CINAHL). The inclusion criteria focused on peer-reviewed articles involving children/youth (under 18) with a neurodevelopmental diagnosis, specifically examining hospital ED usage or visitation. A total of 5447 studies were screened using Covidence software, with 502 proceeding to full-text screening, including 61 case reports. Results Case reports included several behavioural presentations from conditions including Down syndrome, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability. ASD and ADHD emerged as the most common NDDs presenting to the ED, comprising about 41% of all 502 studies. Children with NDDs incurred higher healthcare costs and faced more barriers to adequate care compared to their neurotypical peers. Additionally, autistic children were brought to the ED for various health concerns, including physical injuries from attempted suicide, bone fractures, constipation, psychiatric hospitalizations, and non-traumatic dental conditions Conclusion The findings of this review have significant practical implications for healthcare systems, policymakers, and clinicians, as they can inform strategies to improve access to appropriate care and support for neurodivergent children, alleviating the burden on EDs. Our review will also highlight gaps in the literature requiring further research to provide equitable care to children with NDDs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.025 | 0.022 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".