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Hospitalizations of Children With Neurologic Disorders in the United States

Moreau, Jacqueline F. BA1; Fink, Ericka L. MD1,2; Hartman, Mary E. MD, MPH3; Angus, Derek C. MD, MPH1; Bell, Michael J. MD2; Linde-Zwirble, Walter T.4; Watson, R. Scott MD, MPH1

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p 801–810
doi: 10.1097/PCC.0b013e31828aa71f
Neurocritical Care

Objectives: Although neurologic disorders are among the most serious acute pediatric illnesses, epidemiologic data are scarce. We sought to determine the scope and outcomes of children with these disorders in the United States.

Design: Retrospective cohort study.

Setting: All nonfederal hospitals in 11 states encompassing 38% of the U.S. pediatric population.

Patients: Children 29 days to 19 years old hospitalized in 2005.

Interventions: None.

Measurements and Main Results: Using International Classification of Diseases, 9th Revision, Clinical Modification, codes, we identified admissions with neurologic diagnoses, analyzed patient and hospitalization characteristics, and generated age- and sex-adjusted national estimates. Of 960,020 admissions in the 11 states, 10.7% (103,140) included a neurologic diagnosis, which yields a national estimate of 273,900 admissions of children with neurologic diagnoses. The most common were seizures (53.9%) and traumatic brain injury (17.3%). Children with neurologic diagnoses had nearly three times greater ICU use than other hospitalized children (30.6% vs 10.6%, p < 0.001). Neurologic diagnoses were associated with nearly half of deaths (46.2%, n = 1,790). Among ICU patients, children with neurologic diagnoses had more than three times the mortality of other patients (4.8% vs1.5%, p < 0.001). Children with neurologic diagnoses had a significantly longer median hospital length of stay than other children (3 d [1, 5] vs 2 d [2, 4], p < 0.001) and greater median hospital costs ($4,630 [$2,380, $9,730] vs $2,840 [$1,520, $5,550], p < 0.001).

Conclusions: Children with neurologic diagnoses account for a disproportionate amount of ICU stays and deaths compared with children hospitalized for other reasons.

1Department of Critical Care Medicine, the CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), University of Pittsburgh, Pittsburgh, PA.

2Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, the Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.

3Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

4ZD Associates LLC, Perkasie, PA.

This research was exempt from approval at the University of Pittsburgh.

The dataset was cleaned and coded by Ms. Moreau, Dr. Hartman, Mr. Linde-Zwirble, and Dr. Watson. Analysis and data interpretation was performed by Ms. Moreau and Dr. Watson. This article was drafted by Ms. Moreau. This article was revised by Drs. Fink, Angus, Bell, Hartman, and Watson. All authors approved of the final version.

Ms. Moreau received funding from the National Institutes of Health (NIH) T-35 Start-Up Program (#5TL1RR024155). Dr. Fink received funding from NIH. Dr. Angus received funding from NIH (NIH T-35 Start-up training grant). Dr. Watson received funding from NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies