Impact of CoVID-19 pandemic on multidisciplinary follow-up and clinical outcomes among pediatric spina bifida patients

Abstract

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.