Reasons for Hospital Admissions Among Youth and Young Adults With Cerebral Palsy

doi:10.1016/j.apmr.2010.10.002

Archives of Physical Medicine and Rehabilitation

Volume 92, Issue 1, January 2011, Pages 46-50

https://doi.org/10.1016/j.apmr.2010.10.002 Get rights and content

Abstract

Young NL, McCormick AM, Gilbert T, Ayling-Campos A, Burke T, Fehlings D, Wedge J. Reasons for hospital admissions among youth and young adults with cerebral palsy.

Objective

To identify the most common reasons for acute care hospital admissions among youth (age range, 13–17.9y) and young adults (age range, 23–32.9y) with cerebral palsy (CP).

Design

We completed a secondary analysis of data from the Canadian Institute for Health Information (CIHI) to determine the most frequently observed reasons for admissions and the associated lengths of stay (LOS).

Setting

Participants were identified from 6 children's treatment centers in Ontario, Canada.

Participants

Health records data from youth with CP (n=587) and young adults with CP (n=477) contributed to this study.

Interventions

Not applicable.

Main Outcome Measures

The most common reasons for hospital admission, relative frequencies of admissions for each reason, and mean LOS were reported.

Results

The analysis of CIHI records identified epilepsy and pneumonia as the top 2 reasons for admissions in both age groups. Both age groups were commonly admitted because of infections other than pneumonia and urinary tract infections (UTIs), gastrointestinal (GI) problems such as malabsorption, and mental illness. The reasons that were unique to youth included orthopedic and joint-related issues, other respiratory problems, and scoliosis. In young adults, mental illness was the third most common reason for admission, followed by lower GI or constipation problems, malnutrition or dehydration, upper GI problems, fractures, and UTIs.

Conclusions

This article provides important clinical information that can be used in the training of physicians and health care providers, and to guide future planning of ambulatory care services to support the clinical management of persons with CP over their lifespan.

Section snippets

Methods

We sought to objectively identify the most common reasons for admissions and associated LOS, based on a secondary analysis of health care services delivery data. Canada provides an ideal context to study the reasons for admissions because universal access to physician services is provided to all citizens through a federally funded health care insurance system. All admissions to acute care hospitals across Canada (with the exception of Quebec) are captured in the CIHI database. This database

Results

CIHI data from a sample of 1064 youth and young adults with CP were analyzed. The mean age ± SD of the youth group was 15.4±1.46 years, and 43.6% were girls. The mean age ± SD of the adult group was 26.3±2.6 years, and 42.3% were women. During the 4-year period studied, 32.2% of youth and 19.3% of young adults were admitted to an acute care hospital at least once. The total number of admissions studied was 609. The annual rates of admission were 180 per 1000 for youth and 98 per 1000 for young

Discussion

This article provides an understanding of the most common reasons for hospital admission, among youth and young adults with CP, based on empirical evidence. This health services analysis also provides statistical estimates of the rates of admissions and LOS for each of these reasons based on a large sample.

The predominant clinical issues leading to admission in both youth and young adults were epilepsy and pneumonia, accounting for 25.4% of admissions among the youth and 23.0% among the young

Conclusions

It is clear that individuals with childhood CP are frequently admitted to the hospital. It behooves clinicians to be aware of the common reasons for admissions and strategize to develop preventive care. Understanding the reasons for these admissions to the hospital and the LOS is an important cornerstone for primary health care providers to facilitate maintenance of health. This is the first article to provide a comprehensive description of the reasons for hospital admissions among youth and

Acknowledgments

We thank the Transition Study Team who supported the initial project from which the present study was generated.

References (22)

J.A. Binks et al.
What do we really know about the transition to adult-centered health care?A focus on cerebral palsy and spina bifida
Arch Phys Med Rehabil
(2007)
N.L. Young et al.
The health and quality of life outcomes among youth and young adults with cerebral palsy
Arch Phys Med Rehabil
(2010)
N.L. Young et al.
Youth and young adults with cerebral palsy: their use of physician and hospital services
Arch Phys Med Rehabil
(2007)
J. Aicardi
Diseases of the nervous system in childhood
(2007)
M. Bax et al.
Proposed definition and classification of cerebral palsy
Dev Med Child Neurol
(2005)
J.L. Hutton et al.
Life expectancy in children with cerebral palsy
BMJ
(1994)
L. Green et al.
Primary care of children with cerebral palsy
Clin Fam Pract
(2003)
K. Williams et al.
Survival in cerebral palsy: the role of severity and diagnostic labels
Dev Med Child Neurol
(1998)
P. Haak et al.
Cerebral palsy and aging
Dev Med Child Neurol
(2009)
C.J. Stevenson et al.
Cerebral palsy: the transition from youth to adulthood
Dev Med Child Neurol
(1997)

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Potentially Preventable Hospitalizations Among Adults With Pediatric-Onset Disabilities
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Citation Excerpt :
Additionally, mortality records suggests that death due to respiratory and cardiovascular conditions are also higher among adults with CP/SB compared with people without CP/SB.8,33 Urinary tract infection is also a common cause of PPH among people with CP/SB.16,34 Using 2006-2010 Nationwide Emergency Department Sample data, Wang et al35 estimated that odds of UTI-related emergency visits for people with SB were 8.7 (P<.001) compared with people without SB.
To examine the risk of any and specific potentially preventable hospitalizations (PPHs) for adults with cerebral palsy (CP) or spina bifida (SB). We hypothesize that PPH risk is greater among adults with CP/SB compared with the general population.
Using January 1, 2007, to December 31, 2017, national private administrative claims data (OptumInsight) in the United States, we identified adults with CP/SB (n=10,617). Adults without CP/SB were included as controls (n=1,443,716). To ensure a similar proportion in basic demographics, we propensity-matched our controls with cases in age and sex (n=10,617). Generalized estimating equation models were applied to examine the risk of CP/SB on PPHs. All models were adjusted for age, sex, race/ethnicity, health indicators, US Census Division data, and socioeconomic variables. Adjusted odds ratios were compared within a 4-year follow-up.
Adults with CP/SB had higher risk for any PPH (odds ratio [OR], 4.10; 95% CI, 2.31 to 7.31), and PPHs due to chronic obstructive pulmonary disease/asthma (OR, 1.85; CI, 1.23 to 2.76), pneumonia (OR, 3.01; 95% CI, 2.06 to 4.39), and urinary tract infection (OR, 6.48; 95% CI, 3.91 to 10.75). Cases and controls who had an annual wellness visit had lower PPH risk (OR, 0.52; 95% CI, 0.41 to 0.67); similarly, adults with CP/SB who had an annual wellness visit compared with adults with CP/SB who did not had lower odds of PPH (OR, 0.75; 95% CI, 0.60 to 0.94).
Adults with pediatric-onset disabilities are at a greater risk for PPHs. Providing better access to preventive care and health-promoting services, especially for respiratory and urinary outcomes, may reduce PPH risk among this patient population.
Incontinence training in children with cerebral palsy: A prospective controlled trial
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Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment.
To investigate the effectiveness of incontinence training with urotherapy in children with CP.
A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis.
Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions.
Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan–Meier survival analysis.
Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure).
Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p < 0.001), frequency of daytime incontinence (p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct toilet posture (p = 0.034) and fecal incontinence (p = 0.026).
Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended.
Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.
Determinants of Hospital-Based Health Service Utilization in Cerebral Palsy: a Systematic Review
2022, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Figure 2 presents the PRISMA flowchart of study selection. We identified 18 articles that described 17 studies for inclusion in the review.3,18-34 The results of 1 study were reported in an original article19 and a follow-up letter20; both articles were included but described as 1 study for the purpose of this review.
To systematically review and synthesize evidence of determinants associated with hospital-based health service utilization among individuals with cerebral palsy (CP).
Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020.
Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilization (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilization.
After initial screen, 2 reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle-Ottawa scale. Determinants of health service utilization were identified and categorized using the Andersen behavioral model.
Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across 8 Andersen model characteristics. Individual predisposing factors such as sex showed no difference in health service utilization; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilization was associated with “individual need” including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants.
CP health service utilization is associated with age, severity and comorbidities. Improved understanding of determinants of health service utilization can support health service access for people with CP.
Effects of additional inspiratory muscle training on mobility capacity and respiratory strength for school-children and adolescents with cerebral palsy: a randomized controlled trial
2021, Brazilian Journal of Physical Therapy
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Respiratory complications are the most common cause of mortality and morbidity.3 Pneumonia is one of the main reasons for hospital admissions accounting for 40% of all deaths in youth and young adults with CP, highlighting the consequence of poor respiratory function on mortality and quality of life in this population.4 Children and adolescents with CP have poor respiratory function, secondary to the disease process.5
Children and adolescents with cerebral palsy often have poor respiratory function, which is often not addressed.
To examine if adding inspiratory muscle training to sensorimotor exercises would improve mobility capacity and respiratory function in children and adolescents with cerebral palsy.
Forty school-children and adolescents with cerebral palsy aged 8–15 years with Gross Motor Function Classification System I–III, participated in this randomized controlled trial. The experimental group received 45 min of sensorimotor physical therapy in addition to 15 min of inspiratory muscle training for 18 sessions over six weeks. In contrast, the control group received 45 min of sensorimotor training session, three times a week over six weeks. The primary outcome measure was the six-minute walk test. The secondary outcome measures were maximal inspiratory and maximal expiratory pressure, as well as pulmonary function tests.
Time by group interaction showed no statistical significance between the groups in any outcome measures except for peak expiratory flow. The mean difference of 9.6 cm H₂O (95% CI: 2.3, 16.8) in the MIP from baseline to 2-month follow-up supports the experimental intervention. Post-training, the between-group mean difference was 19.8 (95% CI: -18.0, 57.6) meter in the six-minute walk test.
Adding inspiratory muscle training to sensorimotor physical therapy did not impact mobility capacity in children and adolescents with cerebral palsy.
Psychiatric disorders in adults with cerebral palsy
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Cerebral palsy (CP) is one of the most common neurological conditions in childhood. Individuals with CP often experience various secondary conditions, including intellectual disability (ID), medical conditions, and psychiatric issues. A large number of youth with CP have psychiatric disorders; however, few studies have examined the prevalence of psychiatric issues in adults with CP at the population-level.
To investigate the prevalence and co-occurrence of psychiatric disorders at the population-level in adults with CP only, and adults with CP and ID.
Using clinical information from seven Canadian data sources, we conducted a retrospective cross-sectional analysis of adults with CP, with and without ID.
Adults with CP were more likely than the general population to have a psychiatric diagnosis, independent of ID status. All psychiatric disorders were more common in individuals with CP than the general population, with the exception of addiction related disorders. In most cases, having an ID substantially increased the risk of having a psychiatric disorder.
Adults with CP are at heightened risk for experiencing psychiatric disorders. Current findings highlight the important role health care providers play in screening for psychiatric issues in individuals with CP.
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: Supported by an operating grant from the Canadian Institutes of Health Research (CIHR; grant no. MOP-64460). Dr Young is the beneficiary of a salary support award from CIHR (grant no. 950-202686).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Reprints are not available from the author.

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Original articleReasons for Hospital Admissions Among Youth and Young Adults With Cerebral Palsy

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgments

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Diseases of the nervous system in childhood

Proposed definition and classification of cerebral palsy

Dev Med Child Neurol

Life expectancy in children with cerebral palsy

BMJ

Primary care of children with cerebral palsy

Clin Fam Pract

Survival in cerebral palsy: the role of severity and diagnostic labels

Dev Med Child Neurol

Cerebral palsy and aging

Dev Med Child Neurol

Cerebral palsy: the transition from youth to adulthood

Dev Med Child Neurol

Original article
Reasons for Hospital Admissions Among Youth and Young Adults With Cerebral Palsy