Treating pediatric hydrocephalus in Australia: a 3-year hospital-based cost analysis and comparison with other studies

2013 ◽  
Vol 11 (4) ◽  
pp. 398-401 ◽  
Author(s):  
Alan Chuong Q. Pham ◽  
Christine Fan ◽  
Brian K. Owler
Keyword(s):  
Average Cost ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Shunt Insertion ◽  
Hospital System ◽  
Children's Hospital ◽  
Pediatric Hydrocephalus ◽  
Children’S Hospital ◽  
Previously Treated ◽  
Cost Per Admission

Object The aim of this study was to quantify the financial costs of surgical intervention in patients with newly diagnosed hydrocephalus and patients with treatment failure or complications of previously treated hydrocephalus between 2007 and 2009 at the Children's Hospital at Westmead in Sydney, Australia. Methods This was a retrospective study of patients who underwent shunt insertion, shunt revision, treatment of an infected shunt, and endoscopic third ventriculostomy (ETV) between 2007 and 2009. Actual hospital costs associated with each inpatient stay were obtained from the accounting office of Children's Hospital at Westmead. Patients with hydrocephalus secondary to trauma, malignancy, or other complex conditions (except myelomeningocele) were excluded. Results Hydrocephalus-related procedures comprised approximately one-third of neurosurgical procedures performed each year. From 2007 to 2009, there were 192 admissions during which 300 procedures were performed for 162 patients. The total cost was $4.78 million (Australian) with an average cost of $1.59 million per year. The cost per admission for shunt insertion and ETV were similar ($13,905 vs $14,128, respectively). The average cost per admission for shunt revision was $9,753. However, shunt infection was associated with 40% of total costs, averaging $83,649 per admission. Management of patients with myelomeningocele undergoing insertion of shunt procedures in the same admission accounted for an average cost of $50,186. Conclusions Hydrocephalus is a chronic condition that imposes a significant and growing economic burden upon the Australian hospital system. Seventy-five percent of hydrocephalus-related hospital expenditure is used to surgically treat patients for complications or failure of previously treated hydrocephalus. Further research into the economic impact of pediatric hydrocephalus on the Australian health care system and concerted research efforts in the area of effective long-term surgical treatment and complication minimization are essential.

scholarly journals Connecting Medical Personnel to Dentists via Teledentistry in a Children's Hospital System: A Pilot Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Kimberly J. Hammersmith ◽  
Macaire C. Thiel ◽  
Matthew J. Messina ◽  
Paul S. Casamassimo ◽  
Janice A. Townsend
Keyword(s):  
New Technology ◽  
Primary Care Clinic ◽  
Dental Trauma ◽  
Medical Personnel ◽  
Urgent Care ◽  
Hospital System ◽  
Care Clinic ◽  
Children's Hospital ◽  
System A ◽  
Children’S Hospital

Investigators evaluated feasibility, acceptability, and sustainability of a teledentistry pilot program within a children's hospital network between March, 2018, and April, 2019. The program connected dentists to medical personnel and patients being treated in urgent care clinics, a primary care clinic, and a freestanding emergency department via synchronous video consultation. Three separate but parallel questionnaires evaluated caregiver, medical personnel, and dentist perspectives on the experience. Utilization of teledentistry was very low (2%, 14/826 opportunities), but attitudes regarding this service were largely positive among all groups involved and across all survey domains. Uptake of new technology has barriers but teledentistry may be an acceptable service, especially in the case of dental trauma.

scholarly journals Pediatric hydrocephalus outcomes in Lusaka, Zambia

2020 ◽  
Vol 26 (6) ◽  
pp. 624-635
Author(s):  
Rebecca A. Reynolds ◽  
Arnold Bhebhe ◽  
Roxanna M. Garcia ◽  
Shilin Zhao ◽  
Sandi Lam ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Descriptive Analysis ◽  
Multivariable Analysis ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Middle Income ◽  
Pediatric Hydrocephalus ◽  
Sub Saharan

OBJECTIVEHydrocephalus is a global disease that disproportionally impacts low- and middle-income countries. Limited data are available from sub-Saharan Africa. This study aims to be the first to describe pediatric hydrocephalus epidemiology and outcomes in Lusaka, Zambia.METHODSThis retrospective cohort study included patients < 18 years of age who underwent surgical treatment for hydrocephalus at Beit-CURE Hospital and the University Teaching Hospital in Lusaka, Zambia, from August 2017 to May 2019. Surgeries included ventriculoperitoneal shunt insertions, revisions, and endoscopic third ventriculostomies (ETVs) with or without choroid plexus cauterization (CPC). A descriptive analysis of patient demographics, clinical presentation, and etiologies was summarized, followed by a multivariable analysis of mortality and 90-day complications.RESULTSA total of 378 patients met the inclusion criteria. The median age at first surgery was 5.5 (IQR 3.1, 12.7) months, and 51% of patients were female (n = 193). The most common presenting symptom was irritability (65%, n = 247), followed by oculomotor abnormalities (54%, n = 204). Postinfectious hydrocephalus was the predominant etiology (65%, n = 226/347), and 9% had a myelomeningocele (n = 32/347). It was the first hydrocephalus surgery for 87% (n = 309) and, of that group, 15% underwent ETV/CPC (n = 45). Severe hydrocephalus was common, with 42% of head circumferences more than 6 cm above the 97th percentile (n = 111). The median follow-up duration was 33 (IQR 4, 117) days. The complication rate was 20% (n = 76), with infection being most common (n = 29). Overall, 7% of the patients died (n = 26). Postoperative complication was significantly associated with mortality (χ2 = 81.2, p < 0.001) with infections and CSF leaks showing the strongest association (χ2 = 14.6 and 15.2, respectively, p < 0.001). On adjusted multivariable analysis, shunt revisions were more likely to have a complication than ETV/CPC or primary shunt insertions (OR 2.45 [95% CI 1.26–4.76], p = 0.008), and the presence of any postoperative complication was the only significant predictor of mortality (OR 42.9 [95% CI 12.3–149.1], p < 0.001).CONCLUSIONSPediatric postinfectious hydrocephalus is the most common etiology of hydrocephalus in Lusaka, Zambia, which is similar to other countries in sub-Saharan Africa. Most children present late with neglected hydrocephalus. Shunt revision procedures are more prone to complication than ETV/CPC or primary shunt insertion, and postoperative complications represent a significant predictor of mortality in this population.

Return to system within 30 days of pediatric neurosurgery

2014 ◽  
Vol 13 (2) ◽  
pp. 216-221 ◽  
Author(s):  
David M. Wrubel ◽  
Kelsie J. Riemenschneider ◽  
Corinne Braender ◽  
Brandon A. Miller ◽  
Daniel A. Hirsh ◽  
...  
Keyword(s):  
Quality Assessment ◽  
Pediatric Neurosurgery ◽  
Administrative Database ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Hospital System ◽  
End Point ◽  
Leading Role ◽  
Neurosurgical Patients ◽  
Assessment Measures

Object Quality assessment measures have not been well developed for pediatric neurosurgical patients. This report documents the authors' experience in extracting information from an administrative database to establish the rate of return to system within 30 days of pediatric neurosurgical procedures. Methods Demographic, socioeconomic, and clinical characteristics were prospectively collected in administrative, business, and operating room databases. The primary end point was an unexpected return to the hospital system within 30 days from the date of a pediatric neurosurgical procedure. Statistical methods were used to identify clinical and demographic factors associated with the primary end point. Results There were 1358 pediatric neurosurgical procedures performed in the Children's Healthcare of Atlanta operating rooms in 2012, with 37.4% of these surgeries being preceded by admissions through the emergency department. Medicare or Medicaid was the payor for 54.9% of surgeries, and 37.6% of surgeries were shunt related. There were 148 unexpected returns to the system within 30 days after surgery, and in 109 of these cases, the patient had a presenting complaint that was attributable to the index surgery (related returns). The most common complaints were headache, nausea, vomiting, or seizure after shunt revision or cranial procedures (n = 62). The next most common reason for re-presentation was for wound concerns (n = 30). Thirty-seven of the 109 related returns resulted in a reoperation. The monthly rate of related returns was 8.1% ± 2.5% over the 12-month study period. When using related returns as the dependent variable, the authors found that patients who underwent a shunt-related surgery were both more likely to unexpectedly return to the system (OR 1.86, p = 0.008) and to require surgery upon readmission (OR 3.28, p = 0.004). Because an extended hospitalization shortened the window of time for readmission after surgery, extended length of stay was protective against return to system within 30 days of surgery. Importantly, if related and unrelated returns were analyzed together as the dependent variable (n = 148), no independent clinical and demographic risk factor could be identified. Conclusions Quality assessment measures need to be clearly and carefully defined, as the definition itself will impact the analytical results. Clinicians must play a leading role in the development of these measures to ensure their clinical meaningfulness.

scholarly journals Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 39
Author(s):  
Nandini Arul ◽  
Irfan Ahmad ◽  
Justin Hamilton ◽  
Rachelle Sey ◽  
Patricia Tillson ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Neonatal Resuscitation ◽  
Individual Performance ◽  
Lessons Learned ◽  
Hospital System ◽  
In Situ Simulation ◽  
Children's Hospital ◽  
Resuscitation Training ◽  
Simulation Based ◽  
Children’S Hospital

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children’s Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children’s Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

The full cost of tonsillectomy at Children’s hospital 1 in 2019

2021 ◽  
Vol 04 (03) ◽  
pp. 95-106
Author(s):  
Dinh Pham ◽  
◽  
Quynh Nguyen
Keyword(s):  
Indirect Cost ◽  
Direct Cost ◽  
Average Cost ◽  
Indirect Costs ◽  
Maintenance Cost ◽  
Full Cost ◽  
Children's Hospital ◽  
Study Results ◽  
Children’S Hospital ◽  
Plasma Peak

Objective: Determine full cost of tonsillectomy at Children’s Hospital 1 in 2019. Methods: Coss–sectional descriptive study 304 tonsillectomy children at Children’s Hospital 1 in 2019. Results: The study results showed that the cost of tonsillectomy (excluding consultation fees and pre-operation tests) depend on surgery devices. The average cost of cautery tonsillectomy was 1,740, 869 VND (68% direct cost, 32% indirect cost), of the coblator tonsillectomy was 3,610,031 VND 84.58% direct cost, 15.46% indirect cost), and of the plasma peak tonsillectomy one was 3,600,124 VND (84.54% direct cost, 15.46% indirect cost). In 3 surgery methods, the percentage’s cost of drugs, medical disposible items, and operation team were the largest share in direct costs; in indirect costs, the percentage of human management was the highest proportion, followed by the percentage of facility maintenance cost, and the percentage of other regular expenses cost was very low. Conclusion: The average cost of cautery tonsillectomy was 1,740, 869 VND, of the coblator tonsillectomy was 3,610,031 VND, and of the plasma peak tonsillectomy one was 3,600,124 VND.This cost is higher than the current hospital fee the patient or the health insurance paid. This implies a mismatch between input costs and hospital rates. Key words: Tonsillectomy cost, Children’s Hospital 1, cautery, Coblator, Plasma Peak Blade.

scholarly journals Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Initial Clinical Characteristics and Outcomes

2020 ◽  
Vol 9 (3) ◽  
pp. 373-377
Author(s):  
Catherine E Foster ◽  
Elizabeth A Moulton ◽  
Flor M Munoz ◽  
Kristina G Hulten ◽  
James Versalovic ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Course ◽  
Patient Evaluation ◽  
Medical Conditions ◽  
Hospital System ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract We describe the clinical course of 57 children with coronavirus disease 2019 (COVID-19) cared for through a single hospital system. Most children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. Systemwide patient evaluation processes allowed for prompt identification and management of patients with COVID-19.

scholarly journals A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children's Hospital from March to June 2020

2020 ◽  
Author(s):  
Catherine E Foster ◽  
Lucila Marquez ◽  
Andrea L Davis ◽  
Elizabeth Tocco ◽  
Tjin H Koy ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Clinical Characteristics ◽  
Healthcare Providers ◽  
Hospitalized Patients ◽  
Hispanic Children ◽  
Hospital System ◽  
Children's Hospital ◽  
Diverse Communities ◽  
Children’S Hospital ◽  
Gastrointestinal Complaints

Abstract Background An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic. Methods We performed a retrospective review of all children presenting to the Texas Children’s Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020 through June 28, 2020.Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests. Results Of 16,554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18-21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and nine patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died. Conclusions A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most children with detection of SARS-CoV-2 had uncomplicated illness courses, some children were critically ill, and two patients died.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

Sign in / Sign up

Export Citation Format

Share Document