Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths

Simon, Tamara D.; Riva-Cambrin, Jay; Srivastava, Rajendu; Bratton, Susan L.; Dean, Jonathan; Kestle, John R. W.

doi:10.3171/ped/2008/1/2/131

Cited by 298 publications

(203 citation statements)

References 14 publications

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“…Neuromuscular CCC was modified to exclude hydrocephalus for more meaningful analysis in our exclusively hydrocephalic cohort as previously described. 20 Preoperative or preshunt ventricle size was used as a proxy for the severity of hydrocephalus. It was measured from preoperative ultrasound, CT, or MRI using the validated frontal and occipital horn ratio (FOHR).…”

Section: Clinical Variablesmentioning

confidence: 99%

“…Most of this morbidity is represented by subsequent reevaluations, readmissions, and procedures associated with CSF shunt revisions and infections. 20 For decades, the pediatric neurosurgical community has aimed to minimize CSF shunt failure, which is defined as either a CSF shunt malfunction requiring revision or a CSF shunt infection. Attempts to identify specific risk factors for shunt failure have been reported previously for both shunt malfunction 1,2,5,17,21,23 and shunt infection.…”

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confidence: 99%

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Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study

Riva-Cambrin

Kestle

Holubkov

et al. 2016

PED

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211

117

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OBJECT The rate of CSF shunt failure remains unacceptably high. The Hydrocephalus Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of hydrocephalus management, the aim of which was to isolate specific risk factors for shunt failure. METHODS The study followed all first-time shunt insertions in children younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and shunt design variables. Shunt failure was defined as shunt revision, subsequent endoscopic third ventriculostomy, or shunt infection. Important a priori–defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 children underwent initial CSF shunt placement between April 2008 and December 2011. Of these, 344 patients experienced shunt failure, including 265 malfunctions and 79 infections. The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first shunt placement (HR 1.6 [95% CI 1.1–2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0–2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2–2.9]) were independently associated with reduced shunt survival. The following had no independent associations with shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on children with CSF shunts for hydrocephalus. It confirms that a young age and the use of the endoscope are risk factors for first shunt failure and that valve type has no impact. A new risk factor—an existing cardiac comorbidity—was also associated with shunt failure.

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Section: Clinical Variablesmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study

Riva-Cambrin

Kestle

Holubkov

et al. 2016

PED

Self Cite

211

117

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“…35 Finally, evidence to guide the provision of optimal inpatient health care for medically complex children remains very limited. High-quality research into the indications, complications, and outcomes of the more common technologyassistance procedures (eg, gastrostomy tubes, tracheostomies, CSF shunts 18,[36][37][38] ), coupled with dissemination of these findings, could substantially improve care for these children.…”

Section: Discussionmentioning

confidence: 99%

“…13 Technologyassistance procedures were defined by using ICD-9-CM procedure codes for gastrostomy (43.1), permanent tracheostomy (31.2×), and extracranial ventricular shunt (02.3×). The use of these procedure codes alone does not distinguish between first-time placement and replacement of devices 18 but identifies hospitalizations in which devices were placed.…”

Section: Measured Attributes Of Medical Complexitymentioning

confidence: 99%

Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

2010

PEDIATRICS

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OBJECTIVES-Hospitalized children are perceived to be increasingly medically complex, but no such trend has been documented. The objective of this study was to determine whether the proportion of pediatric inpatient use that is attributable to patients with a diagnosis of one or more complex chronic condition (CCC) has increased over time and to assess the degree to which CCC hospitalizations are associated with attributes that are consistent with heightened medical complexity.METHODS-A retrospective observational study that used the 1997, 2000, 2003, and 2006 Kids Inpatient Databases examined US hospitalizations for children. Attributes of medical complexity included hospital admissions, length of stay, total charges, technology-assistance procedures, and mortality risk. RESULTS-The proportion of inpatient pediatric admissions, days, and charges increased from 1997 to 2006 for any CCC and for every CCC group except hematology. CCCs accounted for 8.9% of US pediatric admissions in 1997 and 10.1% of admissions in 2006. These admissions used 22.7% to 26.1% of pediatric hospital days, used 37.1% to 40.6% of pediatric hospital charges, accounted for 41.9% to 43.2% of deaths, and (for 2006) used 73% to 92% of different forms of technologyassistance procedures. As the number of CCCs for a given admission increased, all markers of use increased.CONCLUSIONS-CCC-associated hospitalizations compose an increasing proportion of inpatient care and resource use. Future research should seek to improve methods to identify the population of medically complex children, monitor their increasing inpatient use, and assess whether current systems of care are meeting their needs. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 October 22. Chronic illness accounts for the majority of children's hospital days and dollars. 4 A smaller set of CSHCN, termed medically complex children, are perceived to use a disproportionate amount of resources, particularly in the inpatient and tertiary care settings. 5 Consistent and complete identification criteria of this subpopulation for administrative, clinical, and research purposes, however, remains elusive. 5-7 A prototypical medically complex child has a diversity of conditions and multisystem disease; may be technology-dependent; has frequent inpatient admissions; and requires multiple medications, multiple subspecialists, and optimal care coordination across inpatient and outpatient settings. 5 Previous work describing the 6.5% of children with disabilities, 8,9 the nearly 5% of children with multiple chronic conditions, 10 or children with technology dependence 5 likely described sets of children with some degree of medical complexity.For accurate attribution of health care use of medically complex children, an operational definition is needed for use in administrative data sets. One potential method to study medically complex children is to group International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes so...

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“…50 Children with ventriculoperitoneal (VP) shunts, for instance, often undergo multiple admissions and surgeries over the course of their shuntdependent life. In under-resourced settings where timely revision is often compromised by the cost to low-to middle-income families and great distances to neurosurgical centers, shunt failure may be associated with greater mortality than in high-income countries.…”

Section: Increased Health Demand In Minimally Resourced Settingsmentioning

confidence: 99%

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

Muir

Wang

Warf

2016

FOC

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OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

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Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths

Cited by 298 publications

References 14 publications

Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study

Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study

Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

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