Medically Unnecessary Venipuncture in Autism Spectrum Disorder Behavior Assessments

OBJECTIVE: Assess the clinical value of routine laboratory testing in the emergency department (ED) during behavioral disturbance evaluations in children with autism spectrum disorder (ASD). METHODS: A retrospective chart review of patients ages 3 to 21 years with ASD presenting to 3 pediatric EDs with behavioral disturbance from January 2019 to January 2020. Local laboratory standards were used to determine abnormal ranges in ED screening labs. Patients with abnormal findings were reviewed for medical significance, defined as the need for a medical intervention, inpatient observation, or the inclusion of a nonbehavioral diagnostic code due to an abnormal laboratory test result. RESULTS: A total of 209 eligible ED encounters were reviewed. Mean age was 14.5±3.1 years, and 84% were male. Of those, 84% (176/209) received venipuncture for screening labs per protocol, of which 97% (170/176) featured abnormal test results. Only 2 abnormal labs (1%) revealed clinically significant findings. Compared with whites, more patients of non-White race received venipuncture (90% vs. 73%, P =0.001) but less non-whites receiving venipuncture were admitted to psychiatric facilities (44% vs. 62%, P =0.01). CONCLUSION: This study demonstrates that routine screening labs in asymptomatic children with ASD presenting to the ED with behavioral disturbances are often outside the range of normal, but without clinical relevance. This practice may lead to unnecessary and painful venipuncture. Children with ASD are a uniquely vulnerable population for whom we should choose wisely.