Matta Rano, Wallis Christopher J D, Etches Jacob, Saskin Refik, Lorenzo Armando J, Vigil Humberto R, Kodama Ronald T, Radomski Sidney, Nam Robert K, Carr Lesley, Herschorn Sender
Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of Urology, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Can Urol Assoc J. 2023 Jun;17(6):191-198. doi: 10.5489/cuaj.8247.
Individuals with spina bifida (SB) may experience negative health outcomes because of an informal transition from pediatric to adult care that results in using the emergency room (ER ) for non-acute health problems.
We conducted a retrospective, population-based cohort study of all people with SB in Ontario, Canada turning 18 years old between 2002 and 2011. These patients were followed for five years before and after age 18. Primary outcome was the annual rate of ER visits. Secondary outcomes included rates of hospitalization, surgery, primary care, and specialist outpatient care. We estimated the association between age and primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates.
Among the 1215 individuals with SB, there was no trend of ER visits seen with increasing age (relative risk [RR ] 0.99, 95% confidence interval [CI] 0.98-1.02); however, there was a significant increase in the rate of ER visits associated with turning 18 years (RR 1.14, 95% CI 1.03-1.27). Turning 18 years old was also associated with a decreased rate of hospital admissions (RR 0.79, 95% CI 0.66-0.95) and no change in surgeries (RR 0.80, 95% CI 0.64-1.02). Visits to primary care physicians remained stable over the same period (RR 0.96, 95% CI 0.90-1.01), while visits to SB-focused specialists decreased after age 18 (RR 0.81, 95% CI 0.75-0.87).
In patients with SB, the rate of ER visits increased significantly at 18 years old, while hospital admissions and specialist physician visits decreased at the same time. Models of transitional care can aim to reduce non-urgent ER visits and facilitate regular specialist care.
患有脊柱裂（SB）的个体可能会经历不良健康后果，因为从儿科护理到成人护理的非正式过渡导致因非急性健康问题而使用急诊室（ER）。
我们对2002年至2011年期间在加拿大安大略省所有年满18岁的脊柱裂患者进行了一项基于人群的回顾性队列研究。这些患者在18岁之前和之后被随访了五年。主要结局是急诊就诊的年发生率。次要结局包括住院率、手术率、初级保健率和专科门诊就诊率。我们使用负二项式增长曲线模型估计年龄与主要和次要结局之间的关联，并对患者水平的基线协变量进行调整。
在1215名脊柱裂患者中，未发现急诊就诊率随年龄增长而呈现出趋势（相对风险[RR]0.99，95%置信区间[CI]0.98 - 1.02）；然而，与年满18岁相关的急诊就诊率显著增加（RR 1.14，95% CI 1.03 - 1.27）。年满18岁还与住院率降低相关（RR 0.79，95% CI 0.66 - 0.95），且手术率无变化（RR 0.80，95% CI 0.64 - 1.02）。同期，初级保健医生的就诊保持稳定（RR 0.96，95% CI 0.90 - 1.01），而18岁以后专注于脊柱裂的专科医生就诊减少（RR 0.81，95% CI 0.75 - 0.87）。
在脊柱裂患者中，18岁时急诊就诊率显著增加，而住院率和专科医生就诊率同时下降。过渡性护理模式可以旨在减少非紧急急诊就诊并促进定期专科护理。
