Diagnostic Criteria and Differential Diagnosis Poster Presentation

P0253 - Gaps in characterization of bladder dysfunction in clinical care and research (ID 1934)

Speakers
  • A. Gopal
Authors
  • A. Gopal
  • V. Block
  • J. Gelfand
  • A. Green
  • C. Guo
  • A. Suskind
  • R. Bove
Presentation Number
P0253
Presentation Topic
Diagnostic Criteria and Differential Diagnosis

Abstract

Background

Neurogenic bladder dysfunction (BD) affects up to 90% of patients with multiple sclerosis (MS) at some point during the disease course and is a highly debilitating symptom. Despite its prevalence, there are no consensus guidelines for screening and ascertaining BD. These discrepancies could underrepresent the impact of BD on neurological decline.

Objectives

In a cohort of women with MS, we compared clinical notes and research registry scores pertaining to BD. We secondarily evaluated how often Bowel/Bladder Functional System (B/B FS) scores reflected the severity of bladder (rather than bowel) scores.

Methods

For 100 adult women with MS in the University of California, San Francisco longitudinal observational EPIC cohort (epicstudy.ucsf.edu), we retrospectively extracted data on bladder and bowel symptoms and treatments from prospectively collected clinical notes in the electronic medical record and compared them with research-grade B/B FS scores annually collected in the EPIC registry. We performed descriptive statistics to evaluate agreement between the clinical notes (BD) and research B/B FS scores at matching timepoints (within 6 months). Finally, seeking to understand whether the severity of BD could be inferred by the B/B FS, we calculated the frequency that bladder (vs. bowel) symptoms drove a higher B/B FS.

Results

We included 89 women, aged 37 to 77, with at least one matching clinical and research visit; a total of 316 visits were examined. Overall, 63 of the 89 participants (70.7%) experienced BD symptoms per clinical notes. BD symptoms were described in 284 of the 316 visits (89.9%), and research B/B FS scores were available for 283 of these. The severity of BD symptoms matched the research B/B FS in 203 (71.5%) of visits. For the rest, BD symptoms were more severe than research B/B FS for 46 visits and less severe for 34. BD severity “drove” the overall B/B FS score in 280 (98.6%); in contrast, in only 4 visits (1.4%) bowel symptoms were more severe.

Conclusions

We noted moderate discrepancy between clinical notes and research B/B FS; in 10% visits, BD symptoms were not ascertained; and in 16.3% research evaluations, BD symptoms were underscored. Inconsistencies in screening for both clinical care and research point to the need for consensus around consistency of BD symptom ascertainment and B/B FS scoring. Of relevance to interpreting B/B FS in the context of understanding the impact of BD on clinical course, B/B FS in most cases reflected the severity of bladder symptoms.

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