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Co-morbidities Associated With Early Mortality in Adults With Spina Bifida

Dicianno, Brad E., MD; Sherman, Adam, MS; Roehmer, Christian, BA; Zigler, Christina K., PhD, MSEd

American Journal of Physical Medicine & Rehabilitation: December 2018 - Volume 97 - Issue 12 - p 861–865
doi: 10.1097/PHM.0000000000000964
Original Research Articles CME Article . 2018 Series . Number 12

Objective The aims of this quality improvement project were to identify secondary conditions and medical co-morbidities in adult patients with spina bifida and to determine which factors were associated with an earlier age of death.

Design Retrospective chart review of 487 patients who attended the University of Pittsburgh Medical Center Adult Spina Bifida Clinic between August 1, 2005, and June 6, 2017, was conducted.

Results Of 487 patients who had received care at the University of Pittsburgh Medical Center Adult Spina Bifida Clinic, 48 were deceased. The most commonly reported causes of death included infection, respiratory failure, renal failure, shunt malfunction, and metastatic cancer. Underlying co-morbidities and secondary conditions included hydrocephalus, Chiari II malformation, tethered cord, scoliosis, and abnormal renal function. In deceased patients, earlier age of death was significantly associated with myelomeningocele subtype and the presence of hydrocephalus and Chiari II malformation.

Conclusions Clinicians treating individuals with spina bifida should be aware of the potential for earlier mortality in individuals with myelomeningocele, hydrocephalus, and Chiari II malformation, especially with regard to infection, respiratory failure, renal failure, shunt malfunction, and cancer.

To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives Upon completion of this article, the reader should be able to: (1) Discuss the importance of recognizing co-morbidities in adult individuals with spina bifida; (2) Describe secondary conditions and medical co-morbidities associated with spina bifida; and (3) Identify which conditions are associated with earlier age of death in adult individuals with spina bifida.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (BED, CKZ); Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania (BED, AS); and Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (BED, AS, CR, CKZ).

All correspondence should be addressed to: Brad E. Dicianno, MD, Human Engineering Research Laboratories, Bakery Square, 6425 Penn Ave, Suite 400, Pittsburgh, PA 15206.

This study has not previously been presented or published in any form. This study was supported by the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine.

Adam Sherman and Christian Roehmer are in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

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