Clinical and Demographic Factors Linked to Low-Value Emergency Department Visits in Pediatric Patients With Spina Bifida

Purpose:Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida.Materials and Methods:Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We used a control population of patients (younger than 18 years) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed-effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit.Results:In total, we included 22,672 emergency visits by patients with spina bifida. Of these, 20.7% of emergency visits were low value vs 17.7% in controls (P <.001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age (odds ratio [OR], 1.05 [1.04-1.06] per year younger), Hispanic/Latino ethnicity (OR, 1.21 [1.06-1.39] compared with non-Hispanics), Black race (OR, 1.35 [1.16-1.58] compared with White), public insurance (OR, 1.14 [1.01-1.29] compared with private insurance), and genitourinary encounter diagnosis (OR, 1.16 [1.04-1.30]). Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36.Conclusions:Younger age, Hispanic/Latino ethnicity, Black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds of low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals, which warrants further investigation to elucidate best practices.