SALT LAKE CITY—A study conducted by researchers from the University of Utah and Harvard Medical School reveals that children with neurological impairment account for a substantial proportion of inpatient hospitalization and charges in the United States. According to this analysis of more than 25 million pediatric hospitalizations, children with neurological impairment accounted for 5.2 percent of all hospitalizations and approximately 20 percent of all hospital charges.
The study, published in the January 2012 issue of PLoS Medicine, analyzed pediatric hospitalizations recorded in the Healthcare Cost and Utilization Kids’ Inpatient Database (KID) for the years 1997, 2000, 2003, and 2006. During these four years, children with neurological impairment accounted for more than 1.3 million hospitalizations, with an increasing proportion of admissions to children specialty hospitals. Epilepsy and cerebral palsy were the most common diagnoses noted at the time of discharge.
“In the United States, advances in care have led to improved survival of children with NI (neurological impairment), so we expected that children with NI would account for a significant proportion of hospital resources,” says Rajendu Srivastava, M.D., M.P.H., associate professor of pediatrics at the University of Utah School of Medicine and senior author on the study. “However, we were surprised at the enormous charges incurred by these hospital admissions, which accounted for nearly one-third of hospital charges within children’s hospitals.”
NI refers to a broad group of medical conditions that involve the nervous system and result in functional and/or intellectual impairment, including epilepsy, premature birth with brain injury because of oxygen deprivation, and genetic and metabolic disorders that affect the nervous system. Children with NI often have other health issues, such as respiratory and gastrointestinal problems, that complicate their care needs and lead to longer, more expensive hospitalizations. In this study, hospitalizations for children with NI accounted for nearly 25 percent of bed days and 29 percent of all hospital charges within children’s hospitals in 2006.
While the overall proportion of hospitalizations attributable to children with NI did not change significantly over time, the relative impact of these hospital admissions was found to be increasing within specialty hospitals for children, where the percentage of hospitalizations for children with NI increased from 11.7 percent in 1997 to 13.5 percent in 2006. Within non-children’s hospitals, the study authors noted a decreasing trend of hospital admissions for children with NI, suggesting that children with NI may be using children’s hospitals more often to seek care from specialty providers who are more familiar with and more comfortable managing their health problems. The study authors also found a 28 percent increase in hospital admissions among adolescents from 1997 to 2006, which could be due to difficulties in transitioning from pediatric to adult providers.
“Due to the complexity of their medical problems, children with NI need coordinated, multidisciplinary care that addresses not only their neurological impairment, but also the breathing, feeding, digestion, and movement issues associated with NI,” says Srivastava. “As we consider implementing health care reform, we need to understand what is driving the high cost of care for children with NI and determine how well-equipped we are to deliver appropriate quality of care.”
In this study, the majority of admissions for children with NI occurred for non-nervous-system problems. Because of difficulties with feeding and reflux, many children with NI are at risk for a respiratory condition called aspiration pneumonia, in which inhalation of food or fluids from the mouth or stomach causes inflammation of the lungs. Aspiration pneumonia is the leading cause of death among children with NI. However, the study authors found a decrease in the number of admissions for respiratory problems and a rise in the number of admissions associated with feeding tube insertion and surgical procedures to treat reflux.
“One focus of future research is on determining the specific problems that are bringing children with NI into the hospital so we can provide improved care,” says Srivastava. “At the University of Utah, we are in the process of investigating the efficacy of different surgical procedures in preventing admissions due to aspiration pneumonia.”
One limitation of the study was that the KIDS database contains only discharge information, rather than individual patient data, so it was not possible to determine if the trends discovered were due to an increasing number of children with NI or to increased hospital usage by the same children over the study period. Planning is under way for additional studies using the Pediatric Health Information System database, which captures information on individual patients and may provide additional insight into reasons for hospitalization among children with NI.
Joshua Bonkowsky, M.D., Ph.D., assistant professor of pediatrics at the University of Utah, also contributed to this study, which was supported in part by the Children’s Health Research Center at the University of Utah and Primary Children’s Medical Center Foundation.
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|Rajendu Srivastava, M.D., M.P.H.
Associate Professor of Pediatrics , U of U School of Medicine
Science Writer , Office of Public Affairs