The Burden of Pediatric Neurocritical Care in the United States

Williams, Cydni N.; Piantino, Juan; McEvoy, Cynthia; Fino, Nora; Eriksson, Carl

doi:10.1016/j.pediatrneurol.2018.07.013

Cited by 38 publications

(36 citation statements)

References 65 publications

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“…However, multiple domains were often affected (67% of patients with severe disability had changes in $3 separate domains). We found that nearly 1 in 10 PNCC admissions result in death, confirming results from previous administrative data and point-prevalence studies in PNCC 3,4 and showing that PNCC mortality is substantially higher than rates for other PICU cohorts. 12,19 We also found high rates of morbidity that were consistent with previous reports.…”

Section: Discussionsupporting

confidence: 89%

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Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Williams

Eriksson²,

Kirby³

et al. 2019

Hospital Pediatrics

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Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. METHODS: We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N 5 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of $1 from baseline, and severe disability was defined as an FSS change of $3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI). RESULTS: Thirty (9%) patients died. New disability (n 5 103; 35%) and severe disability (n 5 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in $3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability. CONCLUSIONS: PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.

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Section: Discussionsupporting

confidence: 89%

“…These patients frequently require critical care interventions, account for billions of dollars in annual hospital costs, and suffer high rates of mortality and morbidity. 4 However, quantification of detailed outcomes among many PNCC diagnoses is scarce and limits intervention research to improve outcomes for these vulnerable children.…”

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confidence: 99%

Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Williams

Eriksson²,

Kirby³

et al. 2019

Hospital Pediatrics

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“…The six sources that were identified as reporting estimates of the annual incidence of SE in the USA were published between 1996 and 2018 and are shown in Table 3. The reported annual incidence of SE ranged from 3.5 to 41 per 100,000 [11][12][13][14][15][16]. Four studies reported estimates of annual incidence for all ages combined [11][12][13][14], one reported the incidence in an adult population (>20 years of age) [15], and one reported the incidence of SE in a pediatric population (≤20 years of age) [16].…”

Section: Incidence Estimatesmentioning

confidence: 99%

“…The reported annual incidence of SE ranged from 3.5 to 41 per 100,000 [11][12][13][14][15][16]. Four studies reported estimates of annual incidence for all ages combined [11][12][13][14], one reported the incidence in an adult population (>20 years of age) [15], and one reported the incidence of SE in a pediatric population (≤20 years of age) [16]. When considering age, the Richmond (Virginia) study revealed a bimodal (Ushaped) distribution of overall SE incidence with the highest estimates in the first years of life (0-4 years of age) and after 60 years of age [12].…”

Section: Incidence Estimatesmentioning

confidence: 99%

Epidemiology of status epilepticus in the United States: A systematic review

Lü

Faure

Bergamasco

et al. 2020

Epilepsy & Behavior

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Convulsive status epilepticus (CSE) is a life-threatening neurologic emergency, which is defined by the International League Against Epilepsy (ILAE) as bilateral tonic-clonic seizure activity lasting longer than 5 min, while absence status epilepticus (SE) and focal SE are specified as exceeding 10 min. Epidemiological evidence on SE is currently lacking, and the incidence is not well-known, especially in light of changes in the ILAE criteria for SE. The objectives of this systematic literature review were to describe the epidemiology of SE in the US population and the associated burden of illness. Methods: A systematic review, including literature and pragmatic searches, was conducted. Literature searches were performed using MEDLINE, Embase, BIOSIS, and Web of Science electronic databases from inception to February 2019. Pragmatic searches of the gray literature were carried out using Google, Google Scholar, conference proceedings, and ClinicalTrials.gov to identify additional sources. Only US-based studies or multinational studies reporting US data of interest were included. Results: In total, 69 sources were identified. The incidence of all SE in patients of all ages in the USA ranged from 18.3 to 41 per 100,000 people per year. Incidence of all-age CSE rose from 3.5 (1979) to 12.5 (2010) per 100,000 people per year. Status epilepticus incidence followed a bimodal (U-shaped) distribution, with the highest estimates in the first years of life (0-4 years) and after 60 years. Mortality associated with SE varied from 21% over 30 days to 31.2% over 10 years. For CSE, two studies reported similar in-hospital mortalities (9.2% and 10.7%). Median healthcare costs related to SE admission were approximately US$14,500 per adult (17-45 years) and US $8000 per child (0-16 years). Conclusions: There is a lack of recent data on the epidemiology and healthcare burden associated with SE. Reports of SE incidence in the USA are highly variable and predate the 2015 ILAE definition of SE. However, the available data suggest a high burden of illness.

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“…More than 500 000 pediatric patients present to the emergency department for traumatic brain injury and 50 000 require hospitalization in the United States each year. 1,2 From 2001 to 2012, the rate of emergency department visits for a diagnosis of traumatic brain injury or concussion more than doubled among children aged 19 years or younger. 3 Traumatic brain injury leads to a range of long-term morbidities including physical, psychosocial, and neurocognitive deficits.…”

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confidence: 99%

Post-traumatic Headache After Pediatric Traumatic Brain Injury: Prevalence, Risk Factors, and Association With Neurocognitive Outcomes

et al. 2019

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Post-traumatic headache is common after pediatric traumatic brain injury and affects thousands of children every year, but little is known about how headache affects recovery after traumatic brain injury in other symptom domains. We aimed to determine the association between headache and other common symptoms after pediatric traumatic brain injury and explore whether subjective complaints of headache are associated with objective deficits on specialized neurocognitive testing. We conducted a retrospective cohort study of children ages 3-19 years following traumatic brain injury with a completed Sports Concussion Assessment Tool (SCAT) questionnaire. Post-traumatic headache was defined by a score more than 2 on the SCAT question for headache and define headache groups for comparison. In our cohort, we analyzed data from the Delis-Kaplan Executive Function System and the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). Headache was reported in 40 (33%) patients presenting for post-traumatic brain injury care among 121 pediatric traumatic brain injury patients and did not differ by injury severity. Median total SCAT symptom score in the headache group was 5-fold higher compared to patients without headache (median 45.5 vs 9; P < .001). Significantly lower-scaled scores in color naming, matrix reasoning, letter sequencing, and letter switching were also found in the headache group (all P ≤ .03). Our study shows that headache, as reported by patients on the SCAT, is associated with higher symptom scores in all other symptom domains, including sleep, mood, sensory, and cognitive. Headache was also associated with worse objective neurocognitive measures and may identify patients who could benefit from specialized follow-up care and management.

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The Burden of Pediatric Neurocritical Care in the United States

Cited by 38 publications

References 65 publications

Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Epidemiology of status epilepticus in the United States: A systematic review

Post-traumatic Headache After Pediatric Traumatic Brain Injury: Prevalence, Risk Factors, and Association With Neurocognitive Outcomes

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