Screening and surgery for foramen magnum stenosis in children with achondroplasia: a large, national database analysis
Screening and surgery for foramen magnum stenosis in children with achondroplasia: a large, national database analysis
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DOI：
10.3171/2018.9.peds18410
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发表时间：
2019-03-01
影响因子：
1.9
通讯作者：
Maher, Cormac O.
中科院分区：
文献类型：
--
作者：
Nadel, Jeffrey L.;Wilkinson, D. Andrew;Maher, Cormac O.
目的本研究的目的是确定在一个大型的，私人保险的医疗网络中，软骨发育不全儿童的枕骨大孔狭窄的筛查和手术率。方法软骨发育不全儿童的枕骨大孔狭窄的筛查和手术率使用来自大型，2001年至2014年间，美国私人保险医疗保健网络的受益人超过5800万。软骨发育不全和筛查和手术索赔的情况下，确定使用国际疾病分类诊断代码和当前程序术语代码的组合。美国儿科学会（AAP）的实践指南被用来确定筛查trends.RESULTS搜索产生3577名儿童年龄19岁或以下的软骨发育不全。其中，236例符合纳入筛选分析的标准。在筛查队列中，41.9%的患者接受了某种形式的枕骨大孔狭窄筛查，而13.9%的患者根据2005年AAP指南进行了充分和适当的筛查。AAP指南发布后，筛查率显著提高。在队列中的所有儿童中，25例因枕骨大孔狭窄接受了颈髓减压术。接受颈髓减压术的发病率在婴儿期最高（28/1000患者-年），并随着年龄的增长而下降（5/1000患者-年，所有其他年龄段合并）。结论软骨发育不全儿童继续筛查枕骨大孔狭窄，尽管自2005年AAP监测指南发布以来，筛查率有所提高。婴儿手术率最高，随年龄增长而下降。
OBJECTIVE The goal of this study was to determine the rates of screening and surgery for foramen magnum stenosis in children with achondroplasia in a large, privately insured healthcare network.METHODS Rates of screening and surgery for foramen magnum stenosis in children with achondroplasia were determined using de-identified insurance claims data from a large, privately insured healthcare network of over 58 million beneficiaries across the United States between 2001 and 2014. Cases of achondroplasia and screening and surgery claims were identified using a combination of International Classification of Diseases diagnosis codes and Current Procedural Terminology codes. American Academy of Pediatrics (AAP) practice guidelines were used to determine screening trends.RESULTS The search yielded 3577 children age 19 years or younger with achondroplasia. Of them, 236 met criteria for inclusion in the screening analysis. Among the screening cohort, 41.9% received some form of screening for foramen magnum stenosis, whereas 13.9% of patients were fully and appropriately screened according to the 2005 guidelines from the AAP. The screening rate significantly increased after the issuance of the AAP guidelines. Among all children in the cohort, 25 underwent cervicomedullary decompression for foramen magnum stenosis. The incidence rate of undergoing cervicomedullary decompression was highest in infancy (28 per 1000 patient-years) and decreased with age (5 per 1000 patient-years for all other ages combined).CONCLUSIONS Children with achondroplasia continue to be underscreened for foramen magnum stenosis, although screening rates have improved since the release of the 2005 AAP surveillance guidelines. The incidence of surgery was highest in infants and decreased with age.