MP53-15: After adjusting for clinical complexity and social determinants of health, state of residence only factor associated with hospital admissions among children with spina bifida presenting to the Emergency Department.
Introduction: ED use and admissions among children with Spina Bifida (SB) may be influenced by social determinants of health (SDoH). Childhood opportunity index is a validated proxy measure of SDoH. Our aim was to determine whether or not there is an association between COI level and admission rates among children with SB presenting at our institution’s ED between 2016-2020 and determine clinical and non-clinical factors associated with ED admissions. Methods: A retrospective single-institution study of children (age <18 years) with SB presenting to the ED between 2016-2020 was performed. Only encounters for SB-related conditions were included. The primary outcome was hospital admission from the ED. Baseline patient factors (sex, age, race/ethnicity, language, insurance, location of residence, distance from the ED, and COI level) and markers of clinical complexity (SB lesion type, lesion functional level, community ambulation status, and ventricular shunt [VS] status) were collected. Our primary exposure was COI level (high vs. low). We performed descriptive statistics and a random intercept mixed effects multivariable logistic regression (to adjust for patient clustering) to determine factors associated with ED admissions. Results: A total of 165 patients accounted for 598 ED encounters between 2016-2020. Nearly a third of encounters (28%) led to admission; 66% of high COI patients were admitted, while 34% of low COI patients were admitted (p = 0.2). COI level was not significantly associated with admission on adjusted analysis (0.9 [0.5-1.6], p=0.7). Factors that were associated with admission on unadjusted analysis included age, race/ethnicity, language, insurance, location of residence, community ambulation, and VS status. However, on adjusted analysis, only location of residence was significant for admission. Those with a residence outside of the District of Columbia and Maryland areas were significantly more likely to be admitted (Virginia [VA] OR=3.7, p<0.01 and West VA/Pennsylvania/New Jersey/military [OR=9.6, p = 0.049]). Conclusions: At our institution, approximately one-third of ED visits led to hospital admissions. COI level was not found to be associated with hospital admissions. Location of residence was the only factor significantly associated. This finding may suggest the need for better access to local care and community partnerships with the Spina Bifida program. SOURCE OF Funding: None.
