Department of Urology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA.
School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA.
J Pediatr Urol. 2024 Dec;20(6):1187-1191. doi: 10.1016/j.jpurol.2024.08.004. Epub 2024 Aug 12.
The longitudinal, multidisciplinary care of children with spina bifida was disrupted during the CoVID-19 pandemic with unclear effect.
To compare outpatient care utilization and outcomes among children with spina bifida before and during the CoVID-19 pandemic.
A pre-post analysis (2018-2020 vs 2020-2022) comparing outpatient care utilization and clinical outcomes was performed using the onset of the CoVID-19 pandemic as a hinge point. Clinical visits and clinically significant events - ED visits, admissions, UTIs, shunt malfunctions - were tabulated from chart review, and patients not seen in the last two years were called for follow up. Differences between visits and outcomes for individuals during pre- and intra-pandemic periods were calculated, and relationships between demographic variables and care utilization as well as clinical visits and clinical outcomes were evaluated via linear regression.
A total of 216 patients were included, 39 (18%) of whom were lost to follow up intra-pandemic. Mean in-person visits decreased from 3.7 (SD 2.8) pre-pandemic to 2.5 (SD 2.3, p < 0.00) intra-pandemic. Only six patients (0.03%) had virtual visits pre-pandemic vs 95 (44%) intra-pandemic; virtual visits did not equalize mean total visits with those pre-pandemic (3.3 [2.9], p = 0.02). Recent surgery was significantly associated with difference in clinic visits between periods (p < 0.00). Admissions (44 vs 29%, p < 0.00), ED visits (55 vs 43.5%, p < 0.00), and shunt malfunctions (21 vs 12.6%, p = 0.01) were significantly higher pre-pandemic; UTI incidence was similar (34 vs 31%, p = 0.41). Clinic visits were significantly positively associated with ED visits (p = 0.02), admissions (p < 0.00), and shunt malfunctions (p = 0.04). Nearly half (40.5%) of patients lost to follow up were contacted; 30% of patients reported difficulty accessing appointments and 17% accessing supplies during the pandemic.
Despite an increase in telehealth visits during the pandemic, there was a decrease in mean total clinic visits compared to pre-pandemic. Adverse events did not increase during the pandemic period as expected; incidence of all evaluated outcomes was higher pre-pandemic. Additionally, outpatient care utilization during the pandemic was positively associated with ED presentation and shunt malfunction and did not appear to protect against other outcomes.
Though clinical follow-up for pediatric spina bifida patients decreased during the COVID-19 pandemic, clinical outcomes did not acutely worsen. Clinic visits were supplemented but not entirely replaced by telemedicine in this period and were associated with poorer clinical outcomes, possibly reflecting an increase in patients' and families' threshold to engage in outpatient care during the pandemic.
COVID-19 大流行期间，脊髓脊膜膨出患儿的纵向、多学科治疗受到干扰，其具体影响尚不清楚。
比较 COVID-19 大流行前后脊髓脊膜膨出患儿的门诊就诊情况和结局。
采用前后分析（2018-2020 年与 2020-2022 年），以 COVID-19 大流行的开始为时间节点，比较门诊就诊情况和临床结局。通过病历回顾，对临床就诊和临床意义上的事件（急诊科就诊、住院、尿路感染、分流管故障）进行了汇总，并对过去两年未就诊的患者进行了随访。计算了个人在大流行前后就诊期间的差异，并通过线性回归评估了人口统计学变量与就诊情况以及临床就诊与临床结局之间的关系。
共纳入 216 例患者，其中 39 例（18%）在大流行期间失访。大流行期间面对面就诊次数从 3.7 次（标准差 2.8 次）减少到 2.5 次（标准差 2.3 次，p<0.00）。大流行前仅有 6 例（0.03%）接受过虚拟就诊，而大流行期间有 95 例（44%）接受过虚拟就诊；虚拟就诊并没有使就诊总数与大流行前相当（3.3 [2.9]，p=0.02）。近期手术与大流行期间就诊次数的差异有显著相关性（p<0.00）。大流行前的住院（44%比 29%，p<0.00）、急诊科就诊（55%比 43.5%，p<0.00）和分流管故障（21%比 12.6%，p=0.01）显著更高，尿路感染发生率相似（34%比 31%，p=0.41）。急诊科就诊（p=0.02）、住院（p<0.00）和分流管故障（p=0.04）与就诊次数显著正相关。近一半（40.5%）失访患者已联系；30%的患者报告在大流行期间难以预约，17%的患者难以获取供应品。
尽管大流行期间远程医疗就诊有所增加，但与大流行前相比，平均总就诊次数仍有所减少。大流行期间不良事件并未如预期那样增加；所有评估结局的发生率均在大流行前更高。此外，大流行期间的门诊就诊情况与急诊科就诊和分流管故障呈正相关，且似乎并未预防其他结局。
尽管 COVID-19 大流行期间脊髓脊膜膨出患儿的临床随访减少，但临床结局并未急剧恶化。在此期间，远程医疗虽然有所补充，但并未完全替代门诊就诊，并且与较差的临床结局相关，这可能反映出在大流行期间，患者及其家属对参与门诊就诊的门槛有所提高。
