(Research Hub Theater) A Review of Emergency Department and Inpatient Admissions of Adults with Spina Bifida Followed by a Multidisciplinary Clinic

Background and/or Objectives: Given the complexity and common complications of Spina Bifida (SB) many patients work with a multidisciplinary (MD) clinic to address their needs; however, a subset of SB patients are not regularly followed. This project aims to address the difference in frequency and cause for Emergency Department (ED) Visits and Inpatient Admissions (IAs) between these two groups.

Design: Retrospective, cohort study.

Setting: Using MSO Billing Data, patients diagnosed with SB were identified and retrospectively followed over a 5yr period (01/01/17-12/31/21).

Participants: 312 SB patients; 187 MD clinic and 125 non-clinic.

Interventions: not applicable.

Main Outcome Measures: Patients followed by a MD clinic were denoted and an analysis on all ED visits and IAs was performed to establish the admission diagnosis/chief complaint.

Results: 65 of 187 clinic patients (35%) accounted for 178 IAs, while 50 of 125 non-clinic patients (40%) accounted for 101 IAs. 69% of MD clinic patient IAs were admitted from the ED vs 40% of non-clinic patients. MD patients were admitted for infections (37%), shunt procedures (11%), and neurologic complaints (7%), non-clinic for infections (26%), neurologic complaints (12%), and pregnancy (9%). Overall, more non-clinic patients presented to the ED, 38% vs 23%. MD clinic patients presented for urological issues (12%), UTI (11%), and headache (11%), non-clinic patients for musculoskeletal pain (20%), ostomy complications (13%), infections (7%), and headache (3%).

Conclusions: MD clinic patients primarily reported to the ED for SB complications (urological/UTI 23%, shunt 11%), while non-clinic patients presented for musculoskeletal (20%) and ostomy complications (13%). MD clinic patients were more likely to be admitted from the ED than non-clinic patients (69% vs 40%). Receiving preventative care may account for the more serious medical issues that led MD clinic patients to ED visits and IAs. This review shows an opportunity to collaborate with the ED to increase SB patients seen in MD clinics and to conserve ED resources.