P3B211: Caring for Children with Spinal Cord Injury: episodic Visits to the Pediatrician's Office

Background: There is an opportunity to improve quality of care for children with spinal cord injury in outpatient settings by focusing on patient/caregiver needs and developing preventive health strategies. Primary care providers often serve as the first contact when health concerns arise. However, providers may receive little education and training in caring for patients with spinal cord injury.

Methods: A convenience sample of children with spinal cord injury participating in an activity-based physical therapy program and seen in a pediatric primary care office were selected in this cross-sectional retrospective chart review from January 1, 2015 through January 1, 2023. Primary reasons for encounters and diagnoses were identified to explore acute needs of children with spinal cord injury and care-seeking behaviors of caregivers with the overall goal of better understanding common concerns in these patients.

Results: Seventy-four children with spinal cord injury were included with a total of 444 office visits (165 pre-participation visits to establish care, 26 post-participation visits, 34 well visits and 219 acute/episodic visits). Of the 219 acute/episodic visits, the most common reasons were rash/skin lesion (11%), urinary tract infection (9.1%), fever/viral illness (7.3%), upper respiratory infection (6.4%), sprain (5.9%), neurogenic bladder (4.6%), constipation (4.1%), pressure injury (4.1%), pneumonia (3.7%), otitis/otalgia (3.2%), ADHD (3.2%), fracture (3.2%), and dysautonomia (3.2%). Health problems encountered by system were most likely skin (19.2%), urinary (14.2%), musculoskeletal (11.9%), respiratory (11.4%), neurologic (10.5%) and digestive (10.0%). Frequency of episodic visits for secondary health conditions typically associated with spinal cord injury was 46% compared to 54% of visits more likely for conditions unrelated to spinal cord injury.

Conclusion: Children with spinal cord injury often present to pediatric primary care as the first point of contact with acute issues both related and unrelated to spinal cord injury. Understanding reasons for care will help to anticipate health care needs, improve preventive care for children with spinal cord injury and educate pediatric primary care providers.