Spina Bifida Emergency Department visits at a large, urban tertiary care hospital between 2016 - 2020: baseline clinical complexity and social determinants of health may be divergent mediators of diagnostic severity
Jacob C. Smith, MD, Sally Zimmermann, BA, M. Sohel Rana, MBBS, MPH, Elena Johnston, BA, Teresa L. Russell, MS, Ian McCarthy, BA, Bruce M. Sprague, BS, Christina P. Ho, MD, Hans G. Pohl, MD, Briony K. Varda, MD, MPH.
Children's National Hospital, Washington, DC, USA.
BACKGROUND: Among children with spina bifida (SB), there is a paucity of information on Emergency Department (ED) visit diagnoses and how such diagnoses relate to SB. We aimed to characterize ED visit diagnoses at our institution by children with SB, and to identify the proportion of visits directly related to SB and any associated patient or clinical factors. METHODS: A cohort of children with SB <21 years old followed routinely at our institution between 2016 -2020 was identified using billing data and verified via chart review. Baseline patient (age, sex, race, ethnicity, insurance, Childhood Opportunity Index (COI) level) and clinical characteristics (type of SB, level of SB, wheelchair use, ventricular shunt) were collected. All ED visits within our institution were identified and departure diagnoses reviewed. The diagnoses were determined to be related to SB versus not, and then categorized into disease categories and diagnostic subcategories. The unadjusted association between patient characteristics, clinical factors, and diagnostic category to SB-related visits was determined. RESULTS: Among 399 children with SB, 195 patients (49%) accounted for 815 ED visits. The median age per visit was 6.4 years (range 0 - 21). The majority of visits were by female (53%), non-White (83%), non-Hispanic (52%), and publicly insured (86%) children with open SB (67%), supra-sacral functional levels (70%) who use wheeled mobility devices (64%) and had ventricular shunts (55%). SB-related visits made up 72% of ED encounters. A larger proportion of White (19 vs. 9%), Hispanic (50 vs. 41%), children with open SB lesion (70% vs. 59%), supra-sacral functional levels (75 vs. 59%), wheeled mobility device use (68 vs. 56%), and ventricular shunts (60 vs. 40%) had SB-related ED visits (p < 0.05). In addition to race and ethnicity, non-SB-related encounters were more common in children with a low COI level (52 vs 41%) (p < 0.05). There was no difference for age, sex, language, or insurance across the visit cohorts. The most frequent diagnostic categories were genitourinary (31%), gastrointestinal (20%), neurologic (15%), respiratory (13%), and skin-related (12%). For SB-related visits, neurologic (19 vs. 4%), genitourinary (43 vs. 0%), and postoperative (6 vs. 1.3%) problems occurred more frequently than in non-SB-related visits (p < 0.05). Respiratory (22 vs. 9%), HEENT (11 vs. 2%), and skin-related (15 vs. 10%) issues were significantly more common in non-SB-related visits (p < 0.05). There was no difference in the rate of fevers (32 vs. 29%) or gastrointestinal problems (21 vs. 17%) across the cohorts. A third of SB-related visits resulted in hospital admissions. CONCLUSIONS: Among children with SB, SB-related problems accounted for three quarters of ED visits to our institution. Increasing SB clinical complexity was associated with visits for SB-related problems, with genitourinary complaints being the most frequent. A larger proportion of non-SB-related visits were for common childhood illnesses. Low COI - a proxy for adverse social determinants of health - may be a mediator of non-SB-related visits.
Back to 2022 Abstracts