Assessment of Acute Hospital Use and Transfers for Management of Pediatric Seizures

Abstract

IMPORTANCEThe availability of pediatric hospital care for common conditions is decreasing across the US. The consequences of this decrease on access to care for specific conditions need to be evaluated.OBJECTIVE To evaluate the degree of regionalization of pediatric seizure care in the US by characterizing the activity of hospital systems in 6 diverse states. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cross-sectional study used inpatient and emergency department administrative data sets from all acute care hospitals in Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York from 2014. All patients younger than 18 years who visited a hospital and had a primary diagnosis of seizures were included. Data were analyzed between January and June 2019. MAIN OUTCOMES AND MEASURES Characteristics of hospital encounters and pediatric HospitalCapability Index scores of transferring and admitting hospitals. RESULTS Among 57 930 encounters with pediatric patients with seizures (median [range] age, 4[1-11] years; 31 968 [55.2%] boys) identified in 621 acute care hospitals, 15 467 patients (26.7%) were admitted as inpatients and 3748 patients (6.5%) were transferred between acute care hospitals.Among encounters that resulted in transfers between hospitals, seizure was the only diagnosis in 1554 patients (41.5%). A total of 42 463 encounters began as emergency department visits, of which 38 173 encounters (90.0%) resulted in routine discharge. While 536 hospitals (86.3%) transferred children with seizures, only 232 hospitals (37.4%) ever admitted them and only 63 hospitals (10.1%) ever received a pediatric seizure transfer. The median (interquartile range) pediatric Hospital Capability Index score of all hospitals was 0.10 (0.02-0.28), while that of hospitals occasionally admitting pediatric seizure patients was 0.34 (0.22-0.55). However, although most patients who were admitted had brief stays (ie, Յ2 days) and no comorbidities, three-quarters of all admissions (12 002 admissions [77.6%]) were to very highly capable centers (ie, hospitals with pediatric Hospital Capability Index scores >0.75). Across all states, the number of referral hospitals for pediatric seizures was less than the number of Dartmouth Atlas Hospital Referral Regions (47 referral hospitals vs 63 hospital referral regions). CONCLUSIONS AND RELEVANCEThese findings suggest that although children with seizures are seen in almost all acute care hospital emergency departments, most hospitals transfer children who require admission. Condition-specific interhospital dependency challenges standard definitions of network adequacy and should be accounted for in emergency medical service planning, access to care policies, and health services research.

Availability of Inpatient Pediatric Surgery in the United States

“…This index is designed to capture the range of conditions for which a hospital routinely provides definitive care. 32 As a measure of the breadth and depth of hospitals services, it has been successfully applied in previous studies 2,3,15,[32][33][34] and can be stratified by variables of interest such as age, sex, race, or insurance status. For the Hospital Capability Index calculation, primary admitting diagnosis ICD-9-CM codes are mapped to one of the 266 conditions specified by the Healthcare Cost and Utilization Project Clinical Classification.…”

“…Pediatric versus adult hospital capabilities may be calculated and compared through age stratification. 2,3,34 When stratifying by age, adult Hospital Capability Index denotes calculations based only upon adult encounters, and the pediatric Hospital Capability Index reflects calculations based only upon pediatric (less than 18 yr old) encounters. From this perspective, large general hospitals that care for adults with a broad range of conditions but do not admit children will carry high adult Hospital Capability Indices and low pediatric Hospital Capability Indices.…”

“…Although the pediatric Hospital Capability Index may vary widely among hospitals, independent children's hospitals studied over multiple years have returned pediatric Hospital Capability Indices of 0.75 or higher. 2,3,15,32,34 For the state analysis, hospitals were classified as general acute care hospitals, freestanding children's hospitals, specialty hospitals (defined as nongeneral hospitals providing single specialty care in areas such as orthopedics, cancer, otorhinolaryngology, ophthalmology, and burns), and rehabilitation hospitals.…”

The Leading Causes of Recurrent Hospitalization of Neurologically Impaired & Disabled Pediatric Patients in King Abdulaziz Medical City- Jeddah from 2013 to 2017

“…Seizure can also be associated with HIE, especially in the neonatal period, reaching approximately 50% (35,36). Irrespective of the cause, children with seizures are often brought to a healthcare facility for workup or treatment where they are often hospitalized (37). The second highest neurological cause for admission after seizures was hydrocephalus-related complications.…”

“…84 out of 138 of the patients with underlying hydrocephalus have been admitted due to neurological causes, and 34 of those patients had VP shunt insertions or revisions, mostly due to complications and failure. VP shunts' failure is not an uncommon occurrence (18) with an overall complication rate of VP shunt insertion was 35.76% (37). Some of the mentioned complications include shunt blockage (45.94%), shunt infection (16.21%), and shut migration (10.81%).…”