目的:婴儿痉挛(IS)的早期治疗可能是改善神经发育结局的必要条件。现有的研究已导致不确定的建议与治疗的变化。我们的目标是确定全国平均成本,初始诊断检查,治疗,和IS患者的住院时间。
方法:这项回顾性队列研究旨在回顾43个非营利机构<2年的患者数据。获得的数据包括患者人口统计学,逗留时间,入场费,和2004年至2014年使用的治疗方法。收集了成本数据并将其调整为2014年美元,分析了当年的数据。
结果:共有6183名患者符合研究标准(n=3382,55%男性)。四分之三的患者(n=4684,76%)有脑电图,56.4%有脑成像(n=3487),17%(n=1050)接受了腰椎穿刺。在所有患者的住院期间,有三分之二(n=4139,67%)开始了IS的药物治疗。大多数患者开始使用促肾上腺皮质激素(n=2066,33%)或托吡酯(n=1804,29%)。平均住院时间为5.8天,平均调整后费用为18,348美元。随着时间的推移,成本从平均12,534.54美元(2004年)增加到23,391.20美元(2014年),增长了86.6%,显著变化(p<0.01)。这与平均住院时间的增加有关。
结论:IS的诊断检查和药物治疗存在差异,这可能导致住院成本的差异。进一步的研究可能有助于确定增加成本的因素,并改善IS患者的医疗保健利用率。
OBJECTIVE: Early treatment of infantile spasms (IS) may be imperative for improvement of neurodevelopmental outcomes. Existing studies have led to inconclusive recommendations with variation in treatment. Our objective was to determine the national average cost, initial diagnostic workup, treatments, and hospital length of stay for patients with IS.
METHODS: This retrospective cohort study was designed to
review data of patients < 2 years from 43 non-profit institutions. Data obtained included patient demographics, length of stay, admission cost, and treatments used from 2004 to 2014. Cost data were collected and adjusted to 2014 dollars, the year data were analyzed.
RESULTS: A total of 6183 patients met study criteria (n = 3382, 55% male). Three-quarters of patients (n = 4684, 76%) had an electroencephalogram, 56.4% had brain imaging (n = 3487), and 17% (n = 1050) underwent a lumbar puncture. Medication for IS was initiated during inpatient hospital stay in two-thirds of all patients (n = 4139, 67%). Most patients were initiated on corticotropin (n = 2066, 33%) or topiramate (n = 1804, 29%). Average length of stay was 5.8 days with an average adjusted cost of $18,348. Over time there was an 86.6% increase in cost from an average $12,534.54 (2004) to $23,391.20 (2014), a significant change (p < 0.01). This correlated with an increase in average length of stay.
CONCLUSIONS: Variability exists in diagnostic workup and pharmacotherapy initiated for IS, which may lead to differences in the cost of hospital stay. Further studies may help determine contributing factors to increased cost and improve health care utilization for IS patients.