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

Abstract

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.

Feasibility of Using Mobile Health to Promote Self-Management in Spina Bifida

“…For patients with SB, the mean costs of an ED visit and inpatient admission have been estimated at $2,102 and $28,918, respectively. 30 The mean cost of UTIs treated in an outpatient setting is estimated to be $462 for 18-to 29-year-olds with SB and $511 for 30-to 44-yearolds with SB. 31 For cost savings calculations, $462 was used given that the participants in this study had a mean age of 29.6 years, and $462 was the more conservative estimate.…”

Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida

“…Urinary tract infection (UTI) remains a source of morbidity in adults with spina bifida (ASB). Compared to matched controls without spina bifida visiting the emergency room, ASB are 9 times more likely to present with UTI ( 1 ). Best practices for UTI diagnosis and prevention are difficult to discern for several reasons: 90% of ASB manage their bladder with intermittent catheterization (IC) and many have undergone surgical reconstruction of their bladder with bowel segments ( 2 ).…”

Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature

“…✓From the 26 articles included, 19 were retrospective cohorts [ 9 – 14 , 20 , 21 , 41 – 45 , 49 , 51 , 54 – 57 ], 4 were prospective cohorts [ 26 , 46 , 52 , 53 ], 2 were retrospective cross-sectional studies [ 47 , 48 ], and 1 was a case-control study [ 50 ]. We systematically reviewed clinical management of 229,791 patients with MMC whose treatment involved at least one kind of orthopedic intervention.…”

“…We systematically reviewed clinical management of 229,791 patients with MMC whose treatment involved at least one kind of orthopedic intervention. Sixteen studies provided other types of managements, besides orthopedic approaches, which were as follows: 11 (42.31%) urologic management [ 9 – 11 , 44 , 45 , 50 , 51 , 53 , 55 – 57 ], 13 (50%) neurosurgical management [ 9 – 11 , 20 , 43 – 45 , 49 , 50 , 53 , 55 – 57 ], 11 (42.31%) neurologic management [ 9 – 11 , 21 , 44 , 45 , 49 , 53 , 55 – 57 ], and 5 (19.23%) gastrointestinal management [ 9 , 11 , 55 – 57 ]. Moreover, all the studies included described postnatal operations and management.…”