Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure

Abstract

A B S T R A C TPurpose This study investigated clinical practice patterns for admissions due to FS at a national level.Method Discharge records were extracted for patients with FS aged < 6 years for the years 2010-16 using national inpatient database in Japan. We ascertained antiepileptic drug use, diagnostic procedures, healthcare costs, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also investigated correlations between performance of lumbar puncture (LP), and use of head computed tomography (CT) and antibiotics.Results We identified a total of 94,452 eligible patients. Hospitalization costs and LOS in days decreased from 19,027 JPY and 4.6 days in 2010 to 18,753 JPY and 4.1 days in 2016. Phenytoin use decreased from 1.6% in 2010 to 0.5% in 2016, whereas fosphenytoin use increased from 0% in 2010 to 6.7% in 2016. Decreasing trends were observed in CT use (from 32.8% to 16.9%) and LP performance (16.9% to 13.5%). For the analyses at hospital levels, CT use and LP performance was positively correlated (r = 0.63). No correlations were observed between total and extremely broad-spectrum antibiotic use and CT use or LP performance in hospitals without cases of intensive care. Wide variations were observed across hospitals for performance of LP (0%-88%), use of CT (0%-84%) and antibiotics (10%-99%).Conclusion We provided novel insights into the current practice patterns for children with FS at individual levels, and delineated wide variations of LP, CT, and antibiotic use for the practices at hospital levels.

Recent treatment patterns and variations for pediatric acute encephalopathy in Japan

“…The trend may have reflected a decrease in LOS and overall natural trends in pediatric inpatients in Japan. Similar decreasing patterns were observed in other common pediatric infectious and neurologic disorders including febrile seizure [26][27][28][29][30].…”

Trends in hospitalization and readmission for pediatric epilepsy and underutilization of epilepsy surgery in the United States

“…Detailed clinical information and laboratory data were unavailable in the NIS and NRD due to restrictions on the database. Therefore, we were unable to clearly delineate clinical practice patterns and evaluate the clinically relevant nuances of the patterns as the previous studies did using other databases [20].…”

“…Also, patients who had undergone epilepsy surgery, peripheral neurostimulator implantation (PNS), responsive neurostimulator implantation (RNS)/intracranial monitoring (ICM) were abstracted based on ICD-9CM procedure codes (brain surgery, 0124-5, 0131, 0151-3, 0159; PNS, 0492, 8694−98; RNS/ICM, 0120, 0293) referring to the previous studies (Supplemental Table 2). Patients with febrile seizure (780.31) were excluded because we had already analyzed the inpatient data for febrile seizure in the previous studies [20,21]. Furthermore, we excluded patients with brain tumors (191.xx, 198.3, 255.0-2), vascular malformation (747.81), and brain injury (800-4, 851-4, 430-2).…”

Quality Indicators in Paediatric and Perinatal Care in Japan: Development and Feasibility Testing

“…Few paediatric and perinatal QIs have been developed in Japanese settings to date; the quality of care in paediatrics and perinatal care in Japan is not guaranteed or validated. Indeed, evidence suggests that there is signi cant practise variation among paediatric patients with asthma[8], febrile seizures [9], acute encephalopathy [10], and brain tumours [11] implying that performance may vary by facility, provider, and region.…”