Identification of Children With High-Intensity Neurological Impairment

Thomson, Joanna; Feinstein, James A.; Hall, Matt; Butts, Breann; Berry, Jay G.

doi:10.1001/jamapediatrics.2019.2672

Cited by 26 publications

(42 citation statements)

References 6 publications

(8 reference statements)

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“…[1][2][3][4][5][6] Much of the morbidity and mortality of children with NI arises from these co-occurring chronic conditions. [6][7][8] To optimize the health and well-being of children with NI, screening and proactive management is important to detect, monitor, and treat these co-occurring chronic conditions. [9][10][11] Moreover, it is paramount to counsel the families of children with NI on the likelihood of experiencing co-occurring chronic conditions, including when they are most likely to arise in their children's lives.…”

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confidence: 99%

Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment

et al. 2021

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BACKGROUND: Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI. METHODS: This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity. RESULTS: The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7–3.8), 4.6 (95% CI 4.5–4.7), and 5.1 (95% CI 5.1–5.2). An increasing percentage of children had ≥9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years. CONCLUSIONS: Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.

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Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment

et al. 2021

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“…Children with neurological complex chronic conditions (CCC) are a vulnerable population with underlying diagnoses including, but not limited to, cerebral palsy (CP), congenital brain and spinal cord malformations, and muscular dystrophy. 1,2 An important commonality in children with CCC are functional limitations and pain due to serious musculoskeletal problems, including hip disease. [3][4][5] Hip reconstruction surgeries (soft tissue release with varus derotation osteotomy and/or pelvic osteotomy) optimize hip alignment, stability, and function, and improve pain and health-related quality of life.…”

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confidence: 99%

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Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions

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DiFazio

Melvin

et al. 2020

Develop Med Child Neuro

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To assess how co-occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs). METHOD This was a retrospective analysis of 4058 children age 4 years or older with neurological CCCs who underwent hip reconstructive surgery between 1st January 2015 and 31st December 2018 in 49 children's hospitals. The presence of co-occurring chronic conditions was assessed using the Agency for Healthcare Research Chronic Condition Indicator system. Multivariable, hierarchical regression was used to assess the relationship between co-existing conditions and postoperative hospital length of stay (LOS), cost, and 30day readmission rate. RESULTS The most common co-occurring conditions were digestive (60.1%) and respiratory (37.9%). As the number of co-existing conditions increased from one to four or more, median LOS increased 67% (3d [interquartile range {IQR} 2-4d] to 5d [IQR 3-8d]); median hospital cost increased 41%

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“…Hospitalizations of children with NI aged 1 to 18 years at CCHMC between January 2010 and September 2015 were eligible for inclusion if they had a principal discharge diagnosis indicative of ARI and required increased respiratory support from baseline during hospitalization. NI was defined as a high‐intensity, chronic neurological diagnosis with substantial functional impairments according to previously defined diagnosis codes 1,10 . ARI was identified using codes in the Clinical Classification Software (Agency for Healthcare Research and Quality, Rockville, MD) respiratory group indicative of ARI (eg, pneumonia, bronchiolitis, influenza; Appendix Table).…”

Section: Methodsmentioning

confidence: 99%

“…NI was defined as a high-intensity, chronic neurological diagnosis with substantial functional impairments according to previously defined diagnosis codes. 1,10 ARI was identified using codes in the Clinical Classification Software (Agency for Healthcare Research and Quality, Rockville, MD) respiratory group indicative of ARI (eg, pneumonia, bronchiolitis, influenza; Appendix Table ).…”

Section: Study Populationmentioning

confidence: 99%

Discharge Before Return to Respiratory Baseline in Children with Neurologic Impairment

et al. 2020

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BACKGROUND: Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline. OBJECTIVE: To determine if discharge before return to respiratory baseline is associated with reutilization among children with NI hospitalized with ARI. METHODS: This single-center retrospective cohort study included children with NI aged 1 to 18 years hospitalized with ARI who required increased respiratory support between January 2010 and September 2015. The primary exposure was discharge before return to respiratory baseline. The primary outcome was 30-day hospital reutilization. A generalized estimating equation was used to examine the association between exposure and outcome while accounting for within-patient clustering and patient-level clinical complexity and illness severity. RESULTS: In the 632 hospitalizations experienced by 366 children, children were discharged before return to respiratory baseline in 30.4% of hospitalizations. Compared with those hospitalizations in which children were discharged at baseline, hospitalizations with a discharge before return to respiratory baseline were more likely to be for privately insured, technology-dependent children with respiratory comorbidities. Compared with discharges at respiratory baseline, discharges with increased respiratory support had no difference in 30-day reutilization (32.8% vs 31.8%; P = .81; adjusted OR 0.80, 95% CI 0.51-1.26). CONCLUSIONS: Among children with NI hospitalized with ARI, discharge before return to respiratory baseline was common, but it was not associated with hospital reutilization. Return to respiratory baseline may not be a necessary component of discharge criteria in this population.

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Identification of Children With High-Intensity Neurological Impairment

Cited by 26 publications

References 6 publications

Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment

Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment

Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions

Discharge Before Return to Respiratory Baseline in Children with Neurologic Impairment

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