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Does Emergency Care Differ for Patients with Spina Bifida Between Pediatric and General Emergency Departments?
Background
As patients with spina bifida (SB) transition from pediatric care, establishing care with adult providers is challenging. The emergency department (ED) may become a primary source of care. It has not been studied if patients with SB who go to a pediatric vs. general ED receive different care.
Methods
We used the Nationwide Emergency Department Sample (NEDS) from 2006-2011. Pediatric EDs were defined as those that had 90% of visits accounted for by patients <19 years of age. Pediatric patients were defined as <19 years of age, while transition patients were 19 or older. All visits with SB (ICD 9 741.s and 756.17) were included in the analysis. Our primary outcome was admission from the ED. Univariate and multivariate analyses were performed to find associations of hospital and patient level data with the outcome of admission using SURVEYLOGISTIC procedure in SAS v 9.4. Elixhauser comorbidity index was included. We also investigated if age of the patient was an effect modifier for admission from a pediatric vs. general ED.
Results
The estimated population characteristics of visits by patients with SB are seen in Table 1. Table 2 shows the univariate and multivariate results for hospital and patient level predictors of admission. When we looked at the interaction of age of patient and type of ED, we saw that for transition patients seen in a pediatric ED, the odds of admissions are 52% higher than in a general ED (OR=1.52, p=0.0001). For pediatric patients evaluated in a pediatric ED , the odds of admissions are 34% higher than in a general ED (OR=1.32, p=0.0054).
Conclusions
In patients with SB, there are several variables that increase the odds of ED admission. Overall, odds of admission were much higher if the visit was at a pediatric ED, controlling for all other factors. Those patients 19 and older were even more likely to be admitted in a pediatric ED. This study provides national data on differences in ED admission for patients with SB. More research is needed to see why care differs for SB patients being seen in a pediatric vs. general ED.
Table 1. Characteristics of ED Visits by patients with SB, NEDS 2006-2011 **weighted

Characteristics	n( %)
Male Female Missing	119621 (43.2) 157354 (56.8) 133
Age, mean (SD)	28.5 (37.5)
Age categories <19 >=19 Missing	81756 (29.5) 195296 (70.5) 55
Died	1626 (0.6)
Type of ED General ED Pediatric ED	252695 (91.2) 24412 (8.8)
Insurance Public Private Other Missing	178695 (64.6) 86345 (31.2) 11555 (4.2) 513 (0.2)
Teaching Status Teaching Non-teaching	144037 (52) 133070 (48)
Median Income <$39,000 $39,000-$47,999 $48,000-$63,999 >=$64,000 Missing	80663 (29.7) 79294 (29.2) 66951 (24.7) 44507 (16.4) 5691 (2)
Region NE MW South West	41381 (14.9) 74209 (26.8) 103077 (37.2) 58440 (21.1)
Dispo from ED Admitted Not Admitted	107488 (38.8) 169619 (61.2)

Table 2. Predictors of hospital admission, NEDS 2006-2011

	Univariate			Multivariate
Variable	OR		Pr > ChiSq	OR	p-value
Female	0.874	<.0001		0.852	<.0001
Weekend	0.926		0.0002	0.923	0.0011
Median Income:
39,000-47,999	0.980		<.0001	1.022	0.0474
48,000-63,999	1.071		0.5620	1.074	0.9446
>64,000	1.331		<.0001	1.221	0.0009
<39,000 (Ref)
Payer:
Public	0.697		0.0199	0.925	0.6461
Other	0.653		0.0520	0.916	0.7525
Private (Ref)
Hospital Region:
Midwest	0.673		0.0211	0.665	0.0512
South	0.695		0.1022	0.719	0.4843
West	0.674		0.1153	0.645	0.0594
Northeast (Ref)
Teaching Hospital	1.577		<.0001	1.631	<.0001
Metropolitan Area	1.635		<.0001	1.099	0.1357
Transition (>=19 yo)	1.419		<.0001	1.017	0.5865
Pediatric ED	1.063		0.7605	1.322	0.0054
Transition x Pediatric ED				1.149	<.0001