Poster 208 Spasticity Diagnosis Rates in Post-Stroke Adult Patients Among Commercially and Medicare Insured Populations

Abstracts / PM R 8 (2016) S151-S332 improvement in gait speed using a cane. Over the ensuing 4 months after discharge home, her gait progressively worsened such that she required Lofstrand crutches despite consistent participation in outpatient physical therapy, and pump dose escalation to 160 mcg/ day over 6 follow-up visits. Setting: Outpatient spasticity clinic. Results: She underwent elective colonoscopy in October 2015 and a loop of intrathecal catheter was incidentally discovered within her descending colon lumen. Abdominal imaging confirmed catheter penetration of the descending colon with localized extra-colonic fluid and localized free air. She remained entirely asymptomatic except for refractory spasticity. Her pump dosage was decreased and she was restarted on oral baclofen. The patient elected to have the entire pump system removed, which was performed by neurosurgery without complication. She remains on high-dose oral baclofen with significant spasticity and gait difficulty. Discussion: Colonic penetration by an intrathecal catheter is an iatrogenic complication that requires urgent surgical correction. While catheter failure and malpositioned catheter tips have been welldescribed, this is the first reported case of colonic penetration with an intrathecal catheter and resultant loss of pump function. The possibility of catheter malpositioning along its course should be considered when a patient with good test dose response demonstrates worsening function or spasticity refractory to escalating doses of intrathecal baclofen. Conclusions: Providers should be aware that a malpositioned intrathecal catheter can cause loss of ITB pump function, requires surgical correction, and can result in patient dissatisfaction with ITB therapy. Level of Evidence: Level V Poster 208 Spasticity Diagnosis Rates in Post-Stroke Adult Patients Among Commercially and Medicare Insured Populations Sonia Pulgar, MPH (Ipsen Biopharmaceuticals Inc - Basking Ridge, Basking Ridge, New Jersey, United States), George C. Camba, BA, Martin Taylor, DO, PhD, Savreet Bains, MS, Liisa Palmer, PhD, Yuanjie Michael Liang, MS, Dominic Marchese, RPh, David Charles, MD Disclosures: Sonia Pulgar: Employment (full or part-time) - Ipsen Biopharmaceuticals, Stock options or bond holdings - Ipsen Biopharmaceuticals Objective: To describe real-world demographic and clinical characteristics of post-stroke adult patients, and associated spasticity diagnosis rates. Design: Retrospective analysis. Setting: Commercial and Medicare claims data. Participants: This analysis included 117,173 adult (18 years) patients with an incident stroke between 1/1/2010 e 12/31/2012. Patients included were continuously enrolled in their healthcare plan for 12 months prior to and 24 months post-stroke. Interventions: Not applicable. Main Outcome Measures: Spasticity diagnosis rates measured in number of days and patient demographics, including age. Spasticity was defined as having 1 medical claim with International Statistical Classification of Diseases (ICD-9) codes for spasticity (342.10, 342.11 and 342.12) within the 24 months post-stroke. Results: The claims data analyzed included 1,948 (1.66%) poststroke patients diagnosed with spasticity; 1,176 <65 years of age and 772 65 years of age. In the population <65 years of age, most patients diagnosed with spasticity were aged 55-64 (54.8%). Mean time to spasticity diagnosis from incident-stroke was 183.4 days [204.5]. Spasticity diagnosis most frequently occurred at outpatient centers (51.3%). Spasticity diagnosis rates at specialty centers were almost two times higher in the <65 population than 65 population (25.9% vs 14.1%). Most common comorbidities of patients diagnosed

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with spasticity included cerebral artery occlusion (66.4%), hypertension (61.9%), acute cerebrovascular disease (59.2%), benign hypertension (38.1%) and other malaise and fatigue (38.0%). When considering ICD-9 codes that could potentially indicate spasticity (not including 342.10, 342.11, and 342.12), the rate of patients identified was 15.1% (17,700 of 117,173). Conclusions: An analysis of claims from US commercial and Medicaid populations proposes diagnosis rates of spasticity are much lower than published estimates, suggesting that spasticity in post-stroke patients is under-diagnosed. Further research should be done to elucidate diagnosis rates, develop clearer coding for spasticity, and educate patients and physicians about the available treatments for spasticity. Level of Evidence: Level III Poster 209 Vocational Outcome 6 to 15 Years after a Traumatic Brain Injury Jan E. Lexell, MD, PhD (Lund University, Lund, Sweden) Disclosures: Jan Lexell: Consulting fees or other remuneration (payment) - Swedish Paralympic Committee, Sweden, Research Grants Swedish National Centre for Research in Sports, Sweden Objective: To describe vocational outcome 6-15 years after a traumatic brain injury (TBI) among individuals who were productive by working or studying at the time of their TBI, and determine associations with variables related to the time of injury and at follow-up. Design: Cross-sectional cohort survey. Setting: Home and community settings. Participants: Thirty-four individuals with a mild TBI and 45 with a moderate-to-severe TBI were assessed on average 10 years postinjury. Interventions: Not applicable. Main Outcome Measures: Logistic regression was used to determine the association between their current vocational situation and variables related to the time of injury (gender, age, injury severity and educational level) and at follow-up (time since injury, marital status and overall disability as assessed by the Mayo-Portland Adaptability Inventory, MPAI-4). Results: A total of 67% were productive at follow-up. Age at injury, injury severity and the degree of disability at follow-up were strongly associated with being productive. Younger individuals with milder TBI and less severe disability were significantly more likely to be fully productive. No significant associations were found between productivity and gender, education, time since injury or marital status. Conclusions: This study indicates that return to productivity in a longterm perspective after a TBI is possible, in particular when the individual is young, has sustained a mild TBI and has a milder form of overall disability. Level of Evidence: Level II Poster 210 Urine Study Results of Persons with Spinal Cord Injury Presenting for Annual Evaluation Felicia M. Skelton, MD (Baylor College of Medicine, Houston, TX, United States), Larisa Grigoryan, MD, PhD, Jun Ying, MS, Sally A. Homes, MD, Barbara Trautner, MD, PhD Disclosures: Felicia Skelton: I Have No Relevant Financial Relationships To Disclose Objective: This study aimed to examine the urinalysis (UA) and urine culture (UC) results of patients with spinal cord injury (SCI) presenting for a routine annual evaluation. Design: Retrospective Cohort. Setting: Veterans Health Administration (VA) outpatient clinic.