Identifying racial disparities in care for children with spastic cerebral palsy: A single center study.

PURPOSE: Existing evidence identifies racial and ethnic disparities impacting the prevalence and severity of cerebral palsy (CP). There is a paucity of literature examining the impact on associated treatment. METHODS: In this retrospective cohort study, an institutional database search identified outpatient encounters for pediatric patients with spastic CP. Additional filters were used to determine treatments received. For each treatment, the proportion of African American (AA) patients receiving treatment was compared to the proportion of Caucasian (C) patients receiving the same treatment. RESULTS: 3,686 children with spastic CP were seen in outpatient clinics associated with an academic tertiary hospital over a 21-year period. There was no significant difference between the proportion of any treatment compared to the entire sample for AA or C patients. CONCLUSION: In this sample, there was no significant evidence of a racial disparity for AA patients receiving treatments for spasticity. This data is limited by several factors. Further research is needed to determine whether pediatric patients with disabilities are receiving equitable care. Clinicians should consider systematically monitoring their practices to identify areas of bias or inequity in accessing care.

Trajectories of medication use and polypharmacy among children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) may have chronic exposure to polypharmacy to address several medical needs, but there is little research on the topic to inform surveillance methods and clinical practice. OBJECTIVE: To identify the trajectories of medication number and pediatric polypharmacy (≥2 concurrent medications) exposure over 3.5 years among children with CP. METHODS: This cohort study used commercial claims from January 1, 2015, to December 31, 2018 (4-year period). Children with CP, aged 5-18 years by January 1, 2016, and with continuous health plan enrollment for all 4 years, were included and categorized as with or without co-occurring neurological/ RESULTS: Of the 1,252 children with CP, 600 were in the CP only cohort (mean [SD]; age, 11.4 [4.1] years; 46.0% female) and 652 were in the CP + NDDs cohort (age, 11.9 [4.1] years; 41.3% female; 32.7% had ≥2 of the NDDs). For the primary GBTM, 3 trajectory groups were identified for CP only: on average, no prescribed medications (69.7% of the cohort), 1 medication/month (24.8%), and 4 medications/month (5.5%). Five trajectory groups were identified for CP + NDDs: 0 (22.4%), 1 (25.6%), 2 (25.2%), 4 (18.4%), and 6 (8.4%) prescribed medications/month. For the secondary GBTM, 3 trajectory groups were identified for CP only: 80.5% were characterized as negligible probability of polypharmacy exposure, 10.8% as low probability, and 8.7% as high probability. Five trajectory groups were identified for CP + NDDs: 37.9% as negligible probability of polypharmacy exposure, 32.8% as constantly high probability, and 29.2% as changing probability (eg, increasing/decreasing). CONCLUSIONS: Children with CP are chronically exposed to differing levels of polypharmacy. Findings can help establish polypharmacy surveillance practices. Studies need to determine if polypharmaceutical strategies are balanced to optimize health and development for children with CP. DISCLOSURES: Dr Whitney is supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund. The funding source had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Functional decline in hospitalized patients with COVID-19 in the early months of the pandemic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) survivors are at risk of functional decline. To address the current gap in knowledge about post-acute needs of those infected by COVID-19, we examined discharge function data to better prepare patients, providers, and health systems to return patients to optimal levels of functioning. OBJECTIVE: To examine the prevalence of functional decline and related rehabilitation needs at hospital discharge. DESIGN: Prospective chart review. SETTING: Academic tertiary care hospital. PARTICIPANTS: Hospitalized adults with a laboratory confirmed COVID-19 diagnosis, with admission dates between March 4, 2020 and May 1, 2020. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge location; need for outpatient physical, occupational, or speech therapy; need for durable medical equipment at discharge; presence of dysphagia at discharge; functional decline. RESULTS: Three hundred eleven potential cases were reviewed. The final number of cases included in analysis was N = 288; patient ages ranged from 20 to 95 years old (mean 66.80 ± 15.31 years). Nearly 20 % of COVID-19 survivors were discharged to a location other than their home. Forty-five percent of survivors experienced functional decline impacting their discharge. Eighty-seven survivors (80.6%) who showed functional change during hospitalization were referred for additional therapy at discharge. At least 73 (67.6%) of these patients required durable medical equipment at discharge (in 12 cases this was not clearly documented). Twenty-nine (26.7%) of the survivors who showed functional changes had ongoing dysphagia at the time of hospital discharge. Ninety-seven of the survivors (40.6%) were never assessed by a PM&R physician, physical therapist, occupational therapist, or speech language pathologist during their hospitalization. CONCLUSIONS: COVID-19 mortality rates are frequently reported in the media, whereas the effects on function are not as well described. The information provided here highlights the need for rehabilitative services during and after hospitalization for COVID-19.

Hospitalized Patients With COVID-19 and Neurological Complications Experience More Frequent Decline in Functioning and Greater Rehabilitation Needs.

ABSTRACT: The coronavirus disease 2019 has been reported to cause various serious neurological sequelae. However, there is little information available about the impact of the disease and its complications on patients' functional status and their postacute needs. Hence, this study was performed to address the current gap in knowledge about the function and postacute needs of those with neurological complications of coronavirus disease 2019. A prospective chart review was completed for 319 patients admitted with coronavirus disease 2019 between March 4 and May 1, 2020. Primary outcomes included rate of new functional decline, discharge location, need for outpatient physical/occupational/speech therapy, need for durable medical equipment at discharge, and presence of dysphagia at discharge. Patients with neurological complications were compared with patients without neurological complications. Two hundred ninety-six cases were included in the final analysis, and 81 (27.4%) of these patients experienced neurological complications. Results indicated that hospitalized coronavirus disease 2019 patients with neurological complications exhibit a significantly longer length of stay, higher frequency of functional decline, higher mortality rate, and more frequent discharge to a subacute rehabilitation facility (all P < 0.0001). The findings of this study are expected to better prepare patients, providers, and health systems for the postacute needs of those with coronavirus disease 2019 and neurological complications.

Intrathecal baclofen toxicity in a patient with acute kidney injury.

A 9-year old male patient with a past medical history of congenital cytomegalovirus (CMV) infection and spastic quadriplegic cerebral palsy with an intrathecal baclofen pump was admitted to a tertiary care hospital with respiratory depression and unresponsiveness for approximately two days. He had a recent two-week hospital stay for respiratory failure due to pneumonia. After being prescribed antibiotics and being sent home, he had developed copious diarrhea. On readmission, he was found to be dehydrated and in acute renal failure. A physical exam revealed hypotonia throughout, in a patient who typically had spasticity with contractures. The Pediatric Rehabilitation Medicine service was consulted for possible baclofen toxicity. Some signs and symptoms of baclofen toxicity include respiratory depression, seizures, CNS depression, hypotonia, hypotension, absent deep tendon reflexes, lethargy, ataxia, and cardiac arrhythmias. His intrathecal baclofen (ITB) dose was reduced, and signs/symptoms of ITB overdose began to resolve. As renal function improved, spasticity returned, necessitating increase in ITB dosing toward the premorbid dose.