The Burden of Pediatric Neurocritical Care in the United States

Abstract

Background: Disorders requiring pediatric neurocritical care (PNCC) affect thousands of children annually. We aimed to quantify the burden of PNCC through generation of national estimates of disease incidence, utilization of critical care interventions (CCI), and hospital outcomes.

Methods: We performed a retrospective cohort analysis of the Kids Inpatient Database over three years to evaluate pediatric traumatic brain injury, neuro-infection or inflammatory diseases, status epilepticus, stroke, hypoxic ischemic injury after cardiac arrest, and spinal cord injury. We evaluated use of CCI, death, length of stay, hospital charges, and poor functional outcome defined as receipt of tracheostomy or gastrostomy or discharge to a medical care facility.

Results: At least one CCI was recorded in 67,058 (23%) children with a primary neurological diagnosis, and considered a PNCC admission. Over half of PNCC admissions had at least one chronic condition, and 23% were treated in children's hospitals. Mechanical ventilation was the most common CCI, but utilization of CCIs varied significantly by diagnosis. Among PNCC admissions, 8110 (12%) children died during hospitalization and 14,067 (21%) children had poor functional outcomes. PNCC admissions cumulatively accounted for over 1.5 million hospital days and over $4 billion in hospital costs in the study years. Most PNCC admissions, across all diagnoses, had prolonged hospitalizations (more than one week) with an average cost of $39.9 thousand per admission.

Conclusions: This large, nationally representative study shows PNCC diseases are a significant public health burden with substantial risk to children's health. More research is needed to improve outcomes in these vulnerable children.

Keywords: Critical care; Neurology; Pediatric; Stroke; Traumatic brain injury.

Figure 1:

Incidence of primary neurologic admissions and proportion receiving critical care intervention for each diagnosis by year in the United States CCI=Critical Care Intervention; chart shows incidence of admissions per 100,000 United States children per year (bars, leftward y-axis) and percent of total admissions requiring critical care intervention (rightward y-axis) by diagnosis and study year (x-axis). Total height of light gray bars represents total admissions with a primary neurologic diagnosis with dark gray bars showing incidence of admissions receiving critical care intervention. Percent markers represent percent of all primary neurologic admissions within each diagnosis by study year.