Presentation Authors: Rano Matta*, Christopher J.D. Wallis, Humberto Vigil, Armando Lorenzo, Ronald T. Kodama, Robert K. Nam, Sidney B. Radomski, Lesley K. Carr, Sender Herschorn, Toronto, Canada
Introduction: Patients with neuropathic bladder dysfunction associated with spina bifida are typically diagnosed and initially treated by pediatric specialists. Abrupt transition of care to adult practices, often at age 18, has been hypothesized to compromise patient care. However, we lack robust data to support this idea. We hypothesize that if patients lack adequate transitional care, they are more likely seek care in the emergency room during this period for non-urgent issues that do not require hospital admission. Therefore, we evaluated the use of emergency room (ER) care, hospital admissions, and trends in care before and after the age of 18 in children with spina bifida in Ontario, Canada.
Methods: We conducted a retrospective population-based cohort study of patients with spinal dysraphism in Ontario, Canada. We included all patients with spina bifida turning 18 years old in Ontario between Jan 1, 2002 to Dec 31, 2011, with data available at least 5 years before and after the age of 18. The primary outcome was ER visits. Secondary outcomes included hospital admissions. We estimated primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates.
Results: We identified 1,215 individuals diagnosed with spina bifida during the study period. Most of the cohort were females (N=660, 54.3%), and they lived within 50 km of a tertiary-care center (N=764, 62.9%). 503 patients (41.4%) had a diagnosis of neuropathic bladder. The annual rate of ER visits progressively increased from 68 visits per person years at age 13 to 105 visits at age 23. The rate of hospital admissions decreased from 29 admissions per person years at age 13 to 20 at age 23. In adjusted models, age had a null effect (RR 0.99; 95%CI 0.98-1.02), however there was a significant increase in the relative rate of ER visits at age 18 to 23 (RR 1.14; 95%CI 1.03-1.27). Patients in the lowest income quintile (RR 1.31; 95%CI 1.07-1.61), those living further than 50 km from a tertiary center (RR 1.42; 95%CI 1.16-1.73), those diagnosed with neuropathic bowel (RR 1.23; 95%CI 1.08-1.41) or bladder (RR 1.20; 95%CI 1.03-1.40), and those requiring mobility aids (RR 1.76; 95%CI 1.08-2.86) all had increased rates of ER visits.
Conclusions: In children with spina bifida, the rate of ER visits increased significantly from age 18 to 23 relative to age 13 to 18, while hospital admission decreased over the same time. Transitional care should aim to reduce non-urgent emergency room visits, especially in those patients at greater risk of seeking emergency room care.
Source of Funding: Functional Urology Research Group, University of Toronto