Hospital and ED charges for spina bifida care in the United States between 2006 and 2014: Over $2 billion annually.

Inouye, Brian M.; Jiang, Ruiyang; Alkazemi, Muhammad H.; Wang, Hsin-Hsiao S.; Wolf, Steven; Pomann, Gina‐Maria; Tejwani, Rohit; Wiener, John S.; Purves, J. Todd; Routh, Jonathan C.

doi:10.1016/j.dhjo.2019.01.007

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…Total ED and hospital charges were obtained from our hospital data warehouse and were reported as medians with interquartile range (IQR), consistent with recent studies 16‐18 . Charges were adjusted to 2018 dollars using the Bureau of Labor Statistics Consumer Price Index for Hospital and Related Services 19…”

Section: Methodsmentioning

confidence: 99%

“…Total ED and hospital charges were obtained from our hospital data warehouse and were reported as medians with interquartile range (IQR), consistent with recent studies. [16][17][18] Charges were adjusted to 2018 dollars using the Bureau of Labor Statistics Consumer Price Index for Hospital and Related Services. 19 Total adjusted ED charges represent all ED charges, excluding any hospital facility charges from an ED visit (i.e., ED professional and ED facility charges for those discharged home from the ED).…”

Section: Total Chargesmentioning

confidence: 99%

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Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

Becker

Bergmann

Vazquez‐Benitez

et al. 2022

Academic Emergency Medicine

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Objectives: Appendicitis is a common pediatric condition requiring surgery. The pediatric appendicitis risk calculator (pARC) was recently developed to guide clinical care.The objective of this study is to describe resource utilization and clinical outcomes among children with appendix ultrasound (US) scans risk stratified by pARC score.Methods: Prospective enrolled observational cohort single-center study of children aged 5-18, who had an US for suspected appendicitis. We estimated the rate of appendicitis, rate of equivocal US scans, and resource utilization by pARC score strata.Total adjusted charges were determined for low-risk pARC patients compared to discharged emergency department (ED) patients with abdominal pain and complete blood count (CBC) obtained without advanced abdominal imaging.Results: Over the 13-month study period, 407 children were enrolled. The overall rate of appendicitis was 33.4%, and 199 (49%) were male. The observed rate of appendicitis was 3.3% in those with a pARC score of <15% and 96.8% in those with a pARC score of ≥85%. Of enrolled patients, 152 (37.3%) had a pARC score <15%. Of those with a pARC score of <15%, the negative appendectomy rate was 28.6%, and the rate of equivocal US was 49.3%. The rate of CT scans and hospitalizations was 19% and 23%, respectively. Median total charges for patients with pARC <15% with usual care were $3756. Median total charges for patients presenting to the ED with abdominal pain who had a CBC but no advanced abdominal imaging performed was $2484, indicating a potential savings of $1272 per patient. Conclusions:There is a high rate of resource utilization among patients who are low appendicitis risk by pARC score. Outcome variation by pARC scores presents future opportunity to selectively reduce resource utilization in pediatric patients.

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Section: Methodsmentioning

confidence: 99%

Section: Total Chargesmentioning

confidence: 99%

Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

Becker

Bergmann

Vazquez‐Benitez

et al. 2022

Academic Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

“…6 In addition, with inpatient and emergency department healthcare costs for SB-related care estimated at more than $2 billion per year in the US alone, investigating optimal management strategies is paramount for the practice of high value care. 15 Our objective in this narrative review was to review the current literature to provide an overview of proactive and expectant management of pediatric neurogenic bladder dysfunction, with special focus on those with SB. We will focus on diagnostics and treatment with a detailed discussion of each modality in the context of a proactive and expectant strategies.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

Hobbs

Krischak

Tejwani

et al. 2021

RRU

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Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.

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People with disability and health care insurance plans

Turk¹,

McDermott²

2019

Disability and Health Journal

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Hospital and ED charges for spina bifida care in the United States between 2006 and 2014: Over $2 billion annually.

Cited by 10 publications

References 16 publications

Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

People with disability and health care insurance plans

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