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Abstract
Care advances in the United States (US) have led to improved survival of children with neurological impairment (NI). Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level. We conducted a study of 25,747,016 US hospitalizations of children recorded in the Kids' Inpatient Database (years 1997, 2000, 2003, and 2006). Children with NI were identified with International Classification of Diseases, 9th Revision, Clinical Modification diagnoses resulting in functional and/or intellectual impairment. We assessed trends in inpatient resource utilization for children with NI with a Mantel-Haenszel chi-square test using all 4 y of data combined. Across the 4 y combined, children with NI accounted for 5.2% (1,338,590) of all hospitalizations. Epilepsy (52.2% [n = 538,978]) and cerebral palsy (15.9% [n = 164,665]) were the most prevalent NI diagnoses. The proportion of hospitalizations attributable to children with NI did not change significantly (p = 0.32) over time. In 2006, children with NI accounted for 5.3% (n = 345,621) of all hospitalizations, 13.9% (n = 3.4 million) of bed days, and 21.6% (US$17.7 billion) of all hospital charges within all hospitals. Over time, the proportion of hospitalizations attributable to children with NI decreased within non-children's hospitals (3.0% [n = 146,324] in 1997 to 2.5% [n = 113,097] in 2006, p<.001) and increased within children's hospitals (11.7% [n = 179,324] in 1997 to 13.5% [n = 209,708] in 2006, p<0.001). In 2006, children with NI accounted for 24.7% (2.1 million) of bed days and 29.0% (US$12.0 billion) of hospital charges within children's hospitals. Children with NI account for a substantial proportion of inpatient resources utilized in the US. Their impact is growing within children's hospitals. We must ensure that the current health care system is staffed, educated, and equipped to serve this growing segment of vulnerable children.
Highlights
Neurological impairment (NI) comprises a heterogeneous group of static and progressive health conditions that involve the central and peripheral nervous systems and result in functional and/or intellectual impairment
Children with neurological impairment (NI) account for a substantial proportion of inpatient resources utilized in the United States (US)
Main Outcomes We evaluated the number of hospitalizations, total number of days spent in the hospital, and total charges for admissions associated with the NI inclusive and NI restricted admissions for each year
Summary
Neurological impairment (NI) comprises a heterogeneous group of static and progressive health conditions that involve the central and peripheral nervous systems and result in functional and/or intellectual impairment This group includes children with epilepsy, infants who are born prematurely and have hypoxicischemic injury to the brain, and children with genetic and metabolic disorders that affect the nervous system. In the US, many children with NI receive uncoordinated, crisisdriven care that is believed to contribute to excessive health care utilization and cost [7,8,9,10,11] They have a disproportionately high use of emergency care health services, and they experience frequent hospitalizations, with subsequently high readmission rates [12,13]. Such children may have longterm care needs, they may receive crisis-driven, uncoordinated care, even in high-income countries
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