424 - A Retrospective Natural History Study of Rhabdomyolysis in a Diverse Pediatric Hospital: Findings of a Bimodal Age Distribution and Healthcare Disparity

Poster Number: 424
Publication Number: 424.219

Sophia Wu, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Natasha Shur, Children's National Health System, Washington DC, DC, United States; Seth I.. Berger, Children's National Health System, Washington, DC, United States

Background: Rhabdomyolysis causes an inflammatory myolytic cascade leading to elevated creatine kinase (CK) levels, significant muscle pain, risk for kidney injury and even death. Racial and ethnic differences have been reported with a higher predilection in adult African American patients. Therapy is largely limited to fluid resuscitation and supportive care.

Objective: There is a significant unmet need for improved understanding of natural history and mitigating factors in rhabdomyolysis in the pediatric population. Our goal was to review fourteen years of data from a diverse urban Children’s hospital to consider how to improve future care.

Design/Methods: This retrospective study analyzed the medical records of all patients between the age 0-22 admitted for rhabdomyolysis representing 536 admissions for 424 patients between June 27, 2008 and December 7, 2022 (Figure 1).

Results: Among 424 patients ages 0 to 21 years old, there was a bimodal age distribution (Figure 2a). Demographics showed a higher than expected percentage of patients reported from Communities of Color compared to regional census data (Figure 2b). Patients with recurrent rhabdomyolysis admissions had incrementally increased chances of having an Inborn Error of Metabolism (IEM) (Figure 2c). We also looked at additional potential treatments. Dexamethasone was given to 39 admissions, though majority of cases were not given as a treatment for rhabdomyolysis but rather for respiratory indications. Our review revealed significant decreases in CK in those who had received steroids, but further analysis needs to be done to validate the preliminary results.

Conclusion(s): Our study revealed several surprising characteristics about the natural history of rhabdomyolysis, including a bimodal age distribution, disproportionate presentation in patients from Communities of Color, and up to a ten-fold increased risk of patients having an IEM in recurrent rhabdomyolysis cases. Our findings call for increased resources to improve equity and care for understudied diseases like rhabdomyolysis that disproportionately affect underserved populations. When patients present with recurrence or unusual hospital course, genetic consultation should be standardly offered. In addition, we identified corticosteroids as a potential mitigator for rhabdomyolysis. Since standard of care options remain limited, investing in further research on therapies is a pivotal next step. Our team has now been selected to receive funding from Cures Within Reach for a clinical trial comparing Dexamethasone plus standard therapy versus standard therapy alone in rhabdomyolysis patients.