Do children with neurological disabilities use more inpatient resources: an observational study

Abstract

BackgroundAdvances in healthcare have improved the survival of children with neurological disabilities (ND). Studies in the US have shown that children with ND use a substantial proportion of resources in children’s hospitals, however, little research has been conducted in the UK. We aimed to test the hypothesis that children with neurological disabilities use more inpatient resources than children without neurological disabilities, and to quantify any significant differences in resource use.Methods A retrospective observational study was conducted, looking at the number of hospital admissions, total inpatient days and the reason for admissions for paediatric inpatients from January 1st to March 31st 2015. Inpatients were assigned into one of three groups: children without ND, children with one ND, and children with more than one ND.ResultsThe sample population included 942 inpatients (mean age 6y 6mo). Children with at least one ND accounted for 15.3% of the inpatients, 17.7% of total hospital inpatient admission episodes, and 27.8% of the total inpatients days. Neurological disability had a statistically significant effect on total hospital admissions (p < 0.001). Neurological disability also had a statistically significant effect on total inpatient days (p < 0.001). Neurological disability increased the length of inpatient stay across medicine, specialties, and surgery.ConclusionsChildren with ND had more frequent hospital admission episode and longer inpatient stays. We identified a smaller group within this population, with arguably more complex neurological disabilities, children with more than one ND. This group had the highest number of admissions and longest inpatient stays. More frequent hospital admissions and longer inpatient stays may place children with ND at greater risk of the adverse effects of hospitalisations. We recommend further investigations looking at each the effects of the different categories of ND on inpatient resource use, and repeat of this study at a national level and over a longer period of time.

The impact of neurological disorders on hospital admissions for children and young people: a routine health data study

“…Again these are similar to those identified by the US study [1], but the London study found that children with genetic, chromosomal and syndromic conditions had the highest number of hospital admissions followed by children with epilepsy [5]. There is some evidence that cerebral palsy prevalence is increasing in the UK [19] which would fit with our results.…”

“…8.8% of inpatient bed days for 0-14 year olds in England in 2014/15 were for children with a neurological condition (among any of their diagnoses). This figure lies between the results of two studies from the US which showed neurological diagnoses or impairment accounted for 5.2% [1] and 10.3% [2] of child hospital admissions but is lower than the only other UK study which was a single centre study in London [5]. This study found that children with neurological diagnoses accounted for 15.3% of all inpatients and 17.7% of all inpatient admission episodes.…”

“…This study found that children with neurological diagnoses accounted for 15.3% of all inpatients and 17.7% of all inpatient admission episodes. It is not clear whether day case patients were included in this study or not which may account for the difference [5]. The increasing use of resources by children with neurological conditions mirrors that of the US study which assessed trends [1].…”

“…However the only study which has assessed data on hospital usage for children with neurological conditions in the UK was a single centre study in London [5]. Although there are studies which have tracked neurological outcomes for preterm babies [6] and regional disease specific registers e.g.…”

Transition from child-centred to adult-oriented healthcare systems for young people with neurodisability: a scoping review protocol

“…The complexity of this process is amplified for CYP with long-term conditions who are simultaneously negotiating the developmental process of adolescence and independence in managing a long-term condition 13 . Adaptation from a supported environment to one of individual responsibility and independence in self-advocacy and management during this developmental phase is particularly challenging for individuals with neurodisability who may have communication, physical or learning difficulties, higher rates of comorbid health problems 1 , and who utilise healthcare services more intensively than their peers 14 , 15 .…”