Craniotomy for Resection of Pediatric Brain Tumors in the United States, 1988 to 2000: Effects of Provider Caseloads and Progressive Centralization and Specialization of Care

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 553-565 ◽  
Author(s):  
Edward R. Smith ◽  
William E. Butler ◽  
Fred G. Barker
Keyword(s):  
United States ◽  
Brain Tumor ◽  
Mortality Rate ◽  
Multivariate Analyses ◽  
Pediatric Brain Tumor ◽  
High Volume ◽  
The United States ◽  
Mortality Rates ◽  
Discharge Disposition ◽  
Pediatric Brain

Abstract OBJECTIVE Large provider caseloads are associated with better patient outcomes after many complex surgical procedures. Mortality rates for pediatric brain tumor surgery in various practice settings have not been described. We used a national hospital discharge database to study the volume-outcome relationship for craniotomy performed for pediatric brain tumor resection, as well as trends toward centralization and specialization. METHODS We conducted a cross sectional and longitudinal cohort study using Nationwide Inpatient Sample data for 1988 to 2000 (Agency for Healthcare Research and Quality, Rockville, MD). Multivariate analyses adjusted for age, sex, geographic region, admission type (emergency, urgent, or elective), tumor location, and malignancy. RESULTS We analyzed 4712 admissions (329 hospitals, 480 identified surgeons) for pediatric brain tumor craniotomy. The in-hospital mortality rate was 1.6% and decreased from 2.7% (in 1988–1990) to 1.2% (in 1997–2000) during the study period. On a per-patient basis, median annual caseloads were 11 for hospitals (range, 1–59 cases) and 6 for surgeons (range, 1–32 cases). In multivariate analyses, the mortality rate was significantly lower at high-volume hospitals than at low-volume hospitals (odds ratio, 0.52 for 10-fold larger caseload; 95% confidence interval, 0.28–0.94; P = 0.03). The mortality rate was 2.3% at the lowest-volume-quartile hospitals (4 or fewer admissions annually), compared with 1.4% at the highest-volume-quartile hospitals (more than 20 admissions annually). There was a trend toward lower mortality rates after surgery performed by high-volume surgeons (P = 0.16). Adverse hospital discharge disposition was less likely to be associated with high-volume hospitals (P < 0.001) and high-volume surgeons (P = 0.004). Length of stay and hospital charges were minimally related to hospital caseloads. Approximately 5% of United States hospitals performed pediatric brain tumor craniotomy during this period. The burden of care shifted toward large-caseload hospitals, teaching hospitals, and surgeons whose practices included predominantly pediatric patients, indicating progressive centralization and specialization. CONCLUSION Mortality and adverse discharge disposition rates for pediatric brain tumor craniotomy were lower when the procedure was performed at high-volume hospitals and by high-volume surgeons in the United States, from 1988 to 2000. There were trends toward lower mortality rates, greater centralization of surgery, and more specialization among surgeons during this period.

scholarly journals QOL-51. LISTENING BEFORE WE SPEAK: A PATIENT-CENTERED APPROACH TO DEVELOPING RESOURCES FOR PEDIATRIC BRAIN TUMOR SURVIVORS AND THEIR FAMILIES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii440-iii440
Author(s):  
Kathy Riley
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
United States ◽  
Brain Tumor ◽  
Mental Health Professionals ◽  
Pediatric Brain Tumor ◽  
The United States ◽  
Physical And Mental Health ◽  
Pediatric Brain

Abstract In the United States, more than 28,000 children and teenagers live with the diagnosis of a primary brain tumor (Porter, McCarthy, Freels, Kim, & Davis, 2010). In 2017, an estimated 4,820 new cases of childhood primary brain and other central nervous system tumors were expected to be diagnosed in children ages 0 – 19 in the United States (Central Brain Tumor Registry of the United States, 2017). Survivors suffer from lifelong side effects caused by their illness or by various treatments. Commonly identified late effects of treatment include a decline in intellectual functioning and processing speed, performance IQ deficits, memory deficits, psychological difficulties, deficits in adaptive functioning (daily life skills), and an overall decrease in health-related quality of life (Castellino, Ullrich, Whelen, & Lange, 2014). To address the ongoing challenges these survivors and their families face, the Pediatric Brain Tumor Foundation (PBTF) met extensively with working groups comprised of survivors and caregivers to develop the outline for a comprehensive Survivorship Resource Guidebook. In 2019, the PBTF published the guidebook which categorizes survivor and caregiver needs into three primary areas: physical and mental health, quality of life, and working the system. Expert authors included survivors and caregivers themselves in addition to medical and mental health professionals. Key outcomes discovered during the creation and production of this resource highlight how caregivers, survivors and professionals can collaborate to provide needed information and practical help to one segment of the pediatric cancer population who experience profound morbidities as a result of their diagnosis and treatment.

Microvascular Decompression Surgery in the United States, 1996 to 2000: Mortality Rates, Morbidity Rates, and the Effects of Hospital and Surgeon Volumes

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1251-1262 ◽  
Author(s):  
Steven N. Kalkanis ◽  
Emad N. Eskandar ◽  
Bob S. Carter ◽  
Fred G. Barker
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
High Volume ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Charges ◽  
Glossopharyngeal Neuralgia

Abstract OBJECTIVE Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1–195 cases) and 3 cases per surgeon (range, 1–107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.

scholarly journals Using Satellite Images and Deep Learning to Identify Associations Between County-Level Mortality and Residential Neighborhood Features Proximal to Schools: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Joshua J. Levy ◽  
Rebecca M. Lebeaux ◽  
Anne G. Hoen ◽  
Brock C. Christensen ◽  
Louis J. Vaickus ◽  
...  
Keyword(s):  
United States ◽  
Deep Learning ◽  
Mortality Rate ◽  
Satellite Images ◽  
The United States ◽  
Mortality Rates ◽  
Image Features ◽  
County Level ◽  
Crude Mortality Rate ◽  
Crude Mortality

What is the relationship between mortality and satellite images as elucidated through the use of Convolutional Neural Networks?Background: Following a century of increase, life expectancy in the United States has stagnated and begun to decline in recent decades. Using satellite images and street view images, prior work has demonstrated associations of the built environment with income, education, access to care, and health factors such as obesity. However, assessment of learned image feature relationships with variation in crude mortality rate across the United States has been lacking.Objective: We sought to investigate if county-level mortality rates in the U.S. could be predicted from satellite images.Methods: Satellite images of neighborhoods surrounding schools were extracted with the Google Static Maps application programming interface for 430 counties representing ~68.9% of the US population. A convolutional neural network was trained using crude mortality rates for each county in 2015 to predict mortality. Learned image features were interpreted using Shapley Additive Feature Explanations, clustered, and compared to mortality and its associated covariate predictors.Results: Predicted mortality from satellite images in a held-out test set of counties was strongly correlated to the true crude mortality rate (Pearson r = 0.72). Direct prediction of mortality using a deep learning model across a cross-section of 430 U.S. counties identified key features in the environment (e.g., sidewalks, driveways, and hiking trails) associated with lower mortality. Learned image features were clustered, and we identified 10 clusters that were associated with education, income, geographical region, race, and age.Conclusions: The application of deep learning techniques to remotely-sensed features of the built environment can serve as a useful predictor of mortality in the United States. Although we identified features that were largely associated with demographic information, future modeling approaches that directly identify image features associated with health-related outcomes have the potential to inform targeted public health interventions.

scholarly journals SWK-03. CAREGIVER EXPERIENCES FOR PEDIATRIC BRAIN TUMOR PATIENTS AND THEIR FAMILIES AT A DEDICATED MEDICAL SPECIALTY CAMP

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii465-iii465
Author(s):  
Ryan Brownfield ◽  
Barb Galantowicz ◽  
Claire Russell ◽  
Jennifer Chabot ◽  
Scott Coven
Keyword(s):  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Medical Specialty ◽  
The United States ◽  
Structured Interview ◽  
Non Profit ◽  
Institutional Review ◽  
The Future ◽  
Horse Farms ◽  
Pediatric Brain

Abstract BACKGROUND Medical specialty camps have provided children with unique psychosocial experiences; however, dedicated pediatric brain tumor camps are rare in the United States, except in limited locations. This study aimed to glean caregiver perceptions from a dedicated family brain tumor camp, and to learn about the family experience with navigating a neuro-oncology diagnosis. DESIGN: Flying Horse Farms is a non-profit organization located in Mt. Gilead, Ohio and a member of the SeriousFun Children’s Network, a global community of camps and programs serving children with serious illnesses and their families, at no cost. The institutional review board at Ohio University approved this project at Flying Horse Farms in September 2017. Consent from caregivers was obtained prior to participation in the study, which provided the opportunity to complete three separate phases: a pre-camp survey, attend a semi-structured interview during the weekend, and complete a post-camp survey. RESULTS 11 families were present for the weekend, and 10 families consented to participate in all three phases. For 6 families, this was their first experience at Flying Horse Farms. For 9 of the 10 families, the camp met their expectations. Additionally, 9 out of 10 families reported they would be interested in attending a diagnosis specific camp again in the future. CONCLUSIONS This work demonstrates the feasibility of conducting research at a medical specialty camp without restricting the camp experience. Better understanding of the attendee’s attitudes toward camp may enhance the experience and the neuro-oncology journey in the future.

scholarly journals Using Satellite Images and Deep Learning to Identify Associations Between County-Level Mortality and Neighborhood Features

2020 ◽  
Author(s):  
Joshua J. Levy ◽  
Rebecca M. Lebeaux ◽  
Anne G. Hoen ◽  
Brock C. Christensen ◽  
Louis J. Vaickus ◽  
...  
Keyword(s):  
United States ◽  
Deep Learning ◽  
Mortality Rate ◽  
Satellite Images ◽  
The United States ◽  
Mortality Rates ◽  
Image Features ◽  
County Level ◽  
Crude Mortality Rate ◽  
Crude Mortality

AbstractWhat is the relationship between mortality and satellite images as elucidated through the use of Convolutional Neural Networks?BackgroundFollowing a century of increase, life expectancy in the United States has stagnated and begun to decline in recent decades. Using satellite images and street view images, prior work has demonstrated associations of the built environment with income, education, access to care and health factors such as obesity. However, assessment of learned image feature relationships with variation in crude mortality rate across the United States has been lacking. We sought to investigate if county-level mortality rates in the U.S. could be predicted from satellite images.MethodsSatellite images were extracted with the Google Static Maps application programming interface for 430 counties representing approximately 68.9% of the US population. A convolutional neural network was trained using crude mortality rates for each county in 2015 to predict mortality. Learned image features were interpreted using Shapley Additive Feature Explanations, clustered, and compared to mortality and its associated covariate predictors.ResultsPredicted mortality from satellite images in a held-out test set of counties was strongly correlated to the true crude mortality rate (Pearson r=0.72). Learned image features were clustered, and we identified 10 clusters that were associated with education, income, geographical region, race and age. Direct prediction of mortality using a deep learning model across a cross-section of 430 U.S. counties identified key features in the environment (e.g. sidewalks, driveways and hiking trails) associated with lower mortality.ConclusionsThe application of deep learning techniques to remotely-sensed features of the built environment can serve as a useful predictor of mortality in the United States. Although we identified features that were largely associated with demographic information, future modeling approaches that directly identify image features associated with health-related outcomes have the potential to inform targeted public health interventions.

scholarly journals Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

2021 ◽  
Author(s):  
Sourbha S. Dani ◽  
Ahmad N. Lone ◽  
Zulqarnain Javed ◽  
Muhammad S. Khan ◽  
Muhammad Zia Khan ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
The United States ◽  
Mortality Rates ◽  
Percentage Change ◽  
Annual Percentage Change ◽  
Rural Counties ◽  
Average Annual Percentage Change

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

The Impact of BMI on Adult Blunt Trauma Outcomes

2019 ◽  
Vol 85 (12) ◽  
pp. 1354-1362
Author(s):  
Rahman Barry ◽  
Milad Modarresi ◽  
Rodrigo Aguilar ◽  
Jacqueline Sanabria ◽  
Thao Wolbert ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

scholarly journals A survey of naturally occurring diseases of the Syrian hamster

1975 ◽  
Vol 9 (3) ◽  
pp. 179-191 ◽  
Author(s):  
Harland W. Renshaw ◽  
G. L. Van Hoosier ◽  
Norine K. Amend
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Age Groups ◽  
The United States ◽  
Mortality Rates ◽  
Survey Respondent ◽  
Relative Importance ◽  
Review Of The Literature ◽  
Research Activities ◽  
Naturally Occurring

Questionnaires on research activities, mortality rates observed in various age groups, extent of examination of dead hamsters, and natural disease conditions and their relative importance were returned by 24 of 43 organisations surveyed in the United States. The average preweaning mortality rate due to all causes was 11·9%. Comparative data from 6 organisations that raised 87880 hamsters in the calendar year 1971 indicated that 97·5% of total preweaning mortality was due to cannibalism. 13·7% of all animals died before use for experiments. 'Wet-tail' was the most frequently recognized disease (71%), and it was also listed as the most important. Pneumonia was recognized by 43% of the respondents and was most commonly listed as second in importance. A selective review of the literature is presented on those diseases recognized by more than one survey respondent.

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