Medical Diagnosis, ED Visits, and Hospitalizations for Substance Use in U.S. Children's Hospitals: A Retrospective Multi-Center Cohort Study.

BACKGROUND/OBJECTIVES: Adolescents with chronic medical conditions (A-CMCs) are at increased risk for alcohol and other drug (AOD) use and adverse health outcomes. However, little is known about patterns of AOD-related emergency department (ED) visits and hospitalization among A-CMCs. This study investigates ED patterns and associations between AOD use, chronic medical complexity, and race-ethnicity with hospitalization following ED visits. AOD use was categorized into three groups: mainstream substances (e.g., cannabis), illicit/other psychoactive substances (e.g., opioids), and no documented AOD diagnosis. A-CMCs were divided into two groups: chronic conditions (CC) or complex chronic conditions (CCC). METHODS: A retrospective cohort of ED encounters among A-CMCs was analyzed. Data were derived from 45 U.S. children's hospitals participating in the Pediatric Health Information System from 2021 to 2023. Associations were examined using logistic regression, adjusting for covariates. RESULTS: The cohort included 1,098,496 ED visits among A-CMCs (encounter-level counts, which may include repeat visits by the same A-CMC); 72.9% of encounters involved adolescents with CCs (27.1% with CCCs).4.2% of those visits were AOD-related, with most involving mainstream substances in CCs and CCCs groups (78.0% and 76.3%, respectively; p = 0.002). Compared with encounters with no documented AOD diagnosis, AOD-related ED encounters were associated with significantly higher adjusted odds of hospitalization for both mainstream substances (aOR 2.8, 95% CI 2.68-2.94 for CC; aOR 3.7, 95% CI 3.19-4.28 for CCC) and illicit/other psychoactive substances (aOR 2.2, 95% CI 2.03-2.4 for CC; aOR 3.18, 95% CI 2.47-4.09 for CCC; all p < 0.001)There were significant interactions between AOD use type and race/ethnicity within each A-CMC subgroup (p = 0.002), indicating differing patterns of hospitalization across groups. DISCUSSION/CONCLUSIONS: Among A-CMCs, AOD-related ED visits-involving either mainstream or illicit/other psychoactive substances-were associated with increased adjusted odds of hospitalization relative to visits with no documented AOD diagnosis, with mainstream substances accounting for the majority of AOD-related encounters overall. Racial-ethnic differences in hospitalization were observed and may reflect a range of clinical and contextual factors not measured in this study, underscoring the need for standardized AOD screening and evaluation in pediatric settings.