The Cost of Pediatric Stroke Care and Rehabilitation

Abstract

Background and Purpose-There is little data regarding the cost of pediatric stroke care or the elements that contribute to these costs. We examined costs for poststroke care during the first year after diagnosis and compared these costs with the volume of the cerebral infarct and the level of neurological and functional outcome. Methods-We identified 39 children who sustained nontraumatic ischemic or hemorrhagic strokes and confirmed the diagnoses by review of medical and radiology records. Medical costs were tabulated for the year after the diagnosis of stroke. Cerebral infarct volumes were measured from MRI or CT scans. Neurological outcome was assessed by telephone with a modification of the Pediatric Stroke Outcome Measure (PSOM), and functional outcomes were assessed with a standardized quality-of-life measure. Results-The median cost for poststroke care during the year after diagnosis was $42 338 for the entire group. The cost for stroke care was higher for hemorrhagic stroke than for ischemic stroke. Cost had a significant positive correlation with neurological impairment. The modified PSOM score positively correlated with impairments of physical, emotional, social, and school function. Conclusions-The cost of stroke care may be one measure of stroke severity, with more extensive strokes resulting in greater medical costs. In addition, stroke appears to impair children's social ability along with their neurological function. (Stroke. 2008;39:161-165.)

Impact of early transcranial Doppler screening and intensive therapy on cerebral vasculopathy outcome in a newborn sickle cell anemia cohort

“…The cost of a transfusion program with chelation has been estimated to be approximately $40 000/year 32 for deferoxamine or €45 000/year for deferasirox, 33 but a stroke requires not only life-long transfusions with chelation, but also rehabilitation costs of $40 000/year. 34 Compliance to transfusions by families was good in our center, and no severe complications occurred, suggesting that the STOP-I recommendations of TCD screening and transfusion therapy are both efficacious and safe in the "real world," that is, outside of a randomized controlled trial. Two strokes may have been avoided; one, by performing a transfusion as soon as the first abnormal-TCD was detected in 1 patient, and two, by performing MRI/MRA in the patient with unavailable temporal window for TCD assessment.…”

The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort

“…The only prior cost analysis of childhood stroke studied a retrospective sample from an academic children's hospital in Ohio and derived costs from hospital charges. 19 Despite several methodologic differences, they reported comparable median inpatient costs: $22,000 for ischemic stroke and $50,000 for hemorrhagic stroke.…”

“…[16][17][18] Childhood stroke cost data, however, are limited: there has been one published US cost analysis from a single children's hospital. 19 The costs of neonatal stroke have yet to be addressed. The goal of this study was to measure the acute and long-term direct costs of childhood and neonatal stroke in a population of children enrolled in a large Northern Californian managed care plan that maintains comprehensive cost databases.…”

Ventricular Assist Devices for Pediatric Heart Disease

“…Limited data from children would suggest that the risk of stroke is the same if not higher than in adults (Malaisrie et al, 2008). Stroke appears to impair children's social ability along with their neurologic function (Lo et al, 2008). The use of pretransplant VAD has been identified with poorer neurologic function in adults after transplantation (Zierer et al, 2007).…”