Healthcare utilization in patients with spina bifida and bone fractures.
Adrian M Fernandez, Than Kyaw, Debbie Goldberg and 5 others
Patients with spina bifida in California had more bone fractures than an age-matched comparison group, especially in the legs, pelvis, and feet.
The gap narrowed once their higher number of other health conditions was accounted for. Fractures also led to longer hospital stays.
Key findings
118% of the spina bifida group had at least one bone fracture compared with 11% of the comparison group. After adjusting for comorbidities and socioeconomic factors, the adjusted odds were 1.19 times higher.
2Fractures per capita were more than double in the spina bifida group at the leg (2.5x), pelvis (2.4x), foot (2.1x), chest (2.0x), and vertebrae (2.5x).
3Among those with fractures, the spina bifida group had more fracture encounters (mean 1.8 vs 1.4), a higher rate of two or more episodes (36% vs 26%), and longer cumulative hospitalization (9.4 vs 7.6 days).
Still to come
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Fractures were identified by billing and diagnosis codes in administrative records, not by clinical confirmation. A code does not guarantee a true fracture. The data cover California only. Patients who moved into or out of the state during the 13-year study period may have had fractures missed. Fractures in spina bifida can be asymptomatic due to sensory deficits, so some may have gone undiagnosed and are not in the data. The comparison group is the general population, not a group with similar disability. The spina bifida group had a mean comorbidity score of 1.8 versus 0.7, so part of the difference reflects overall health status. The 6-month cutoff for defining a new fracture episode was set by expert opinion, not by a biological rationale, and may misclassify fractures with prolonged healing. With sample sizes of 20,000 and 100,000, small differences become statistically significant even when they may not matter clinically.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read the 18% versus 11% fracture rate as a pure spina bifida effect. The spina bifida group had a mean comorbidity score of 1.8 versus 0.7 in the comparison group, and after adjusting for comorbidities the odds ratio dropped to 1.19. Fractures were also identified by billing codes, not clinical confirmation, so the true rate in either group is uncertain.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →