No abstract

Background Juvenile Huntington's disease (JHD) is a childhood‐onset neurodegenerative disorder. Although it is caused by the same pathologic expansion of CGA repeats as adult‐onset Huntington's disease, JHD has distinct clinical features. Most clinical research in HD focuses in the adult‐onset disease; therefore, little is known about acute care outcomes for patients with JHD. Methods The Kids' Inpatient Database (KID) was used to examine hospitalizations of children with JHD and to determine the diagnoses and procedures associated with inpatient care for JHD. Regression models were built to examine acute care outcomes, including death, length of stay, and disposition at discharge in patients with JHD compared with patients in the general KID data. Results The proportion of JHD cases among hospitalized children was 1.23 per 100,000 KID inpatient stays. Seizures/convulsions (58.5%) and psychiatric conditions (26.1%) were the most common primary or secondary diagnoses among JHD patient hospitalizations. The most common procedure was percutaneous endoscopic gastrostomy tube placement (8.6%). Compared with hospitalizations of the general population, hospitalizations of patients with JHD had a lower odds of discharge to home (adjusted odds ratio [AOR], 0.23; 95% confidence interval [CI], 0.14–0.37) and an increased likelihood of death (AOR, 8.03; 95% CI, 2.98–21.60) or discharge to a short‐term care facility (AOR, 4.44; 95% CI, 2.59–7.61). A diagnosis of JHD was associated with increased length of stay (7.04 vs. 3.75 days; P < 0.01). Conclusions Children with JHD have unique acute care patterns. Future studies are needed to determine the extent to which coordinated care may impact inpatient and disposition needs.

Objective:To describe the prevalence of high adverse childhood experiences (ACEs) among neurology outpatients and determine their association with healthcare utilization rates, and comorbid medical and psychiatric disease.Methods:This was a cross-sectional study of adults seen for outpatient neurology follow-up at the University of Pennsylvania. Participants completed the ACE questionnaire, and depression/ anxiety screenings. Healthcare utilization metrics (ED visits, hospitalizations, and outpatient calls) were obtained for all participants. High ACE scores were defined as a score ≥ 4. The prevalence of high ACE scores in our cohort was compared to US historical controls. Statistical associations adjusted for age, gender, and race/ethnicity.Results:198 patients enrolled in the study. Neurology patients were more likely to have elevated ACE scores compared to US population estimates (23.7% vs 12.6%, p<0.01). High ACE scores were associated with increased ED utilization (OR=21 CI [5.8-76.0] , p<0.01), hospitalizations (OR=5.2, CI [1.7-15.0], p<0.01), and telephone encounters (OR 3, CI [1.1-8.2], p<0.05). High ACEs were also associated with medical and psychiatric comorbidities (OR 5.8, CI [2.0-17.0], p<0.01 and OR 4.5, CI [2.1-9.6], p< 0.01), as well as high depression and anxiety scores (OR= 6.9, CI [2.8-17.0], p<0.01, and OR=4.3, [CI 1.7-11.0], p<0.01).Conclusion:Patients with neurological conditions are more likely to have high ACEs than the US population which was associated with higher rates of healthcare utilization, increased number of medical and psychiatric comorbidities, and higher anxiety and depression scores. Addressing ACEs may be a way to improve the health outcomes of patients with neurological conditions