Emergency Hospital Use More Common for Adults Than Children in Australia

Adults with cerebral palsy (CP) are more likely to be hospitalized on an emergency-care basis than planned care, mainly due to respiratory illness and feeding-tube problems, an Australian study suggests.

This may reflect problems in transitioning from pediatric to adult care for people with CP, and a better understanding of the medical attention these adults seek in an emergency setting could help guide preventive care.

The study, “Profile of hospital admissions for adults with cerebral palsy: a retrospective cohort study,” was published in Developmental Medicine & Child Neurology.

Previous research has shown that children with CP are more likely than their peers to need emergency hospitalization, with common reasons being respiratory (breathing) problems, gut-related symptoms, and epilepsy.

“Whether these trends persist into adulthood in Australian people with CP is unknown,” researchers wrote, adding, “This study is the first to provide evidence of, and detail about, health services usage for adults with CP in Australia.”

These researchers analyzed five years’ worth (from 2013 to 2017) of admissions data from Monash Health — an organization that provides federally funded healthcare to people in and around Melbourne.

Out of over a million individual admissions, 2,922 were for people with cerebral palsy: 2,072 admissions for 413 children (under age 18), and 850 admissions for 138 adults. Both groups were just more than 50% male, and most individuals live in the metropolitan Melbourne area — compared to the adults, a significantly larger portion of pediatric patients were from outside this metro area (18% vs. 10%).

The number of admissions per person ranged from one to 38 in the entire group, with one adult and four children having more than 30 admissions in the five years analyzed. Of the adults, 53 (38.4%) averaged more than one hospital admission each year. The average length of time spent in the hospital was significantly longer for adults (5.2 days) than for children (3.3 days).

Adult admissions were more commonly for emergency reasons (62.1% vs. 25.2%), whereas admissions for children were more commonly planned in advance (72.5% vs. 35.9%).

Cerebral palsy itself was listed as the primary reason for hospital admission for 46% of these children and 4% of the adults.

Other common reasons for hospital admission among adults were respiratory problems (20%), followed closely by issues with feeding tubes (19%). Other common reasons were epilepsy (7%), injuries (6%), and other gastrostomy problems (6%).

The researchers speculated that these findings — particularly the high frequency of emergency room visits among adults — might be indicative of difficulty in transitioning from pediatric to adult healthcare systems for people with CP.

“A proactive approach, preventive interventions, and early detection of ill-health with community treatment is readily available to children with CP in Australia, but may be more challenging to access for adults,” the researchers wrote. “Adults with CP may not be receiving preventive interventions including simple medical screening of potentially life threatening conditions, precipitating emergency admission.”

Similar problems may apply to individual reasons for admission. For instance, regarding feeding tubes (gastrostomy), the researchers wrote: “Information that should be provided to parents to care for their child’s gastrostomy and thus minimize complications has been published; however, with children transitioning to adulthood and different models of care, it is possible that this information is not transferred, increasing emergency crises risk.”

This study provides a snapshot of how adults with cerebral palsy utilize hospital services in Australia. These findings could have implications for primary, preventative care in CP — understanding what the major risks are can shed light on how best to mitigate them. For example, appropriate vaccinations can reduce the risk of certain respiratory infections, while therapies aimed at improving coordination and balance can limit the likelihood of injury-causing falls.

“This study provides baseline information for health care providers and policy makers to inform development of improved models of care for this vulnerable population,” the researchers concluded.