Descriptive analysis of 258 emergency department visits by spina bifida patients

Caterino, Jeffrey M.; Scheatzle, Mark D.; DʼAntonio, James A.

doi:10.1016/j.jemermed.2005.09.005

Cited by 21 publications

(8 citation statements)

References 22 publications

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“…This same survey revealed that only 1 in 5 physicians had discussed transition with the child [8]. Due in part to poor transitional care from pediatric to adult providers an increasingly large proportion of patients with SB are reportedly seeking medical attention at emergency departments rather than from primary and specialty care providers [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of spina bifida transitional care practices in the United States

Kelly

Thibadeau

Struwe

et al. 2017

PRM

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PURPOSE Recent studies have revealed that the lack of continuity in preparing patients with spina bifida to transition into adult-centered care may have detrimental health consequences. We sought to describe current practices of transitional care services offered at spina bifida clinics in the US. METHODS Survey design followed the validated transitional care survey by the National Cystic Fibrosis center. Survey was amended for spina bifida. Face validity was completed. Survey was distributed to registered clinics via the Spina Bifida Association. Results were analyzed via descriptive means. RESULTS Total of 34 clinics responded. Over 90 characteristics were analyzed per clinic. The concept of transition is discussed with most patients. Most clinics discuss mobility, bowel and bladder management, weight, and education plans consistently. Most do not routinely evaluate their process or discuss insurance coverage changes with patients. Only 30% communicate with the adult providers. Sexuality, pregnancy and reproductive issues are not readily discussed in most clinics. Overall clinics self-rate themselves as a 5/10 in their ability to provide services for their patients during transition. CONCLUSIONS Characteristics of current transitional care services and formal transitional care programs at US clinics show wide variances in what is offered to patients and families.

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Section: Introductionmentioning

confidence: 99%

Evaluation of spina bifida transitional care practices in the United States

Kelly

Thibadeau

Struwe

et al. 2017

PRM

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“…The significantly high rate of UTIs and all GU ICD‐9‐CM codes for young adults compared to adolescents, noted in Tables 4 and 5, is particularly interesting, and has been noted in other studies of ER and IP use for persons with SB [4,23]. There are no guidelines for recognition or treatment of bacteriuria in individuals with SB, particularly acute on chronic; therefore the coding of “UTI” may represent both chronic bacteriuria and acute UTIs [17,24].…”

Section: Discussionmentioning

confidence: 83%

Inpatient and Emergency Room Visits for Adolescents and Young Adults With Spina Bifida Living in South Carolina

Mann¹,

Royer²,

Turk³

et al. 2014

PM&R

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Objective To compare emergency room (ER) and inpatient hospital (IP) use rates for persons with spina bifida (SB) to peers without SB, when transition from pediatric to adult health care is likely to occur; and to analyze those ER and IP rates by age, race, socioeconomic status, gender, and type of residential area. Design A retrospective cohort study. Setting Secondary data analysis in South Carolina. Participants We studied individuals who were between 15 and 24 years old and enrolled in the State Health Plan (SHP) or state Medicaid during the 2000–2010 study period. Methods Individuals with SB were identified using ICD-9 billing codes (741.0, 741.9) in SHP, Medicaid, and hospital uniform billing (UB) data. ER and IP encounters were identified using UB data. Multivariable Generalized Estimating Equation (GEE) Poisson models were estimated to compare rates of ER and IP use among the SB group to the comparison group. Main Outcome Measures Total ER rate and IP rate, in addition to cause-specific rates for ambulatory care sensitive conditions (ACSC) and other condition categories. Results We found higher rates of ER and IP use in persons with SB compared to the control group. Among individuals with SB, young adults (those 20–24 years old) had higher rates of ER use due to all ACSC (P = .023), other ACSC (P = .04), and urinary tract infections (UTI; P = .002) compared to adolescents (those 15–19 years old). Conclusions Young adulthood is associated with increased ER use overall, as well as in specific condition categories (most notably UTI) in individuals 15–24 years old with SB. This association may be indicative of changing healthcare access as people with SB move from adolescent to adult health care, and/or physiologic changes during the age range studied.

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“…14–16 Due partly to poor care transition from pediatric to adult providers, an increasingly large proportion of patients with SB reportedly seek medical attention at the ED instead of from primary care providers. 5,17 …”

Section: Discussionmentioning

confidence: 99%

“…Caterino et al similarly reported UTI as the most common ED diagnosis in a single institution ED visit series. 17 Such a high UTI rate in patients with SB raises the concern of improper ambulatory care, since UTI is considered a potentially preventable condition in the outpatient setting. 16,19 A more comprehensive program to prevent UTI in high risk SB cases may be beneficial in SB management.…”

Section: Discussionmentioning

confidence: 99%

Emergent Care Patterns in Patients with Spina Bifida: A Case-Control Study

et al. 2015

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Purpose Individuals with spina bifida are typically followed closely as outpatients by multidisciplinary teams. However, emergent care of these patients is not well defined. We describe patterns of emergent care in patients with spina bifida and healthy controls. Materials and Methods We reviewed Nationwide Emergency Department Sample data from 2006 to 2010. Subjects without spina bifida (controls) were selected from the sample using stratified random sampling and matched to each case by age, gender and treatment year at a 1:4 ratio. Missing emergency department charges were estimated by multiple imputation. Statistical analyses were performed to compare patterns of care among emergency department visits and charges. Results A total of 226,709 patients with spina bifida and 888,774 controls were identified. Mean age was 28.2 years, with 34.6% of patients being younger than 21. Patients with spina bifida were more likely than controls to have public insurance (63.7% vs 35.4%, p <0.001) and to be admitted to the hospital from the emergency department (37.0% vs 9.2%, p <0.001). Urinary tract infections were the single most common acute diagnosis in patients with spina bifida seen emergently (OR 8.7, p <0.001), followed by neurological issues (OR 2.0, p <0.001). Urological issues were responsible for 34% of total emergency department charges. Mean charges per encounter were significantly higher in spina bifida cases vs controls ($2,102 vs $1,650, p <0.001), as were overall charges for patients subsequently admitted from emergent care ($36,356 vs $29,498, p <0.001). Conclusions Compared to controls, patients with spina bifida presenting emergently are more likely to have urological or neurosurgical problems, to undergo urological or neurosurgical procedures, to be admitted from the emergency department and to incur higher associated charges.

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Descriptive analysis of 258 emergency department visits by spina bifida patients

Cited by 21 publications

References 22 publications

Evaluation of spina bifida transitional care practices in the United States

Evaluation of spina bifida transitional care practices in the United States

Inpatient and Emergency Room Visits for Adolescents and Young Adults With Spina Bifida Living in South Carolina

Emergent Care Patterns in Patients with Spina Bifida: A Case-Control Study

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