Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis*
Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis*
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脑外伤危重儿童的住院治疗：纵向分析*
DOI：
10.1097/01.ccm.0000171839.65687.f5
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发表时间：
2005
影响因子：
8.8
通讯作者：
P. Adelson
中科院分区：
文献类型：
--
作者：
J. Tilford;M. Aitken;K. Anand;J. W. Green;A. Goodman;J. G. Parker;Jeffrey B. Killingsworth;D. Fiser;P. Adelson
目的：本研究调查了1988-1999年期间因创伤性脑损伤住院的危重儿童的发病率、手术利用率和结局，以描述改进治疗的益处。设计：使用医疗保健成本和利用项目全国住院患者样本的数据对出院情况进行回顾性分析，该样本约占美国急症护理医院样本的20%。背景：来自美国所有类型社区医院的住院患者。参与者：研究样本包括所有0-21岁的儿童，其主要或次要ICD-9-CM诊断代码为创伤性脑损伤，程序代码为气管插管或机械通气。干预措施：无。测量和主要结果：住院期间发生的死亡被用来计算死亡率。颅内压监测和颅骨手术开口的使用作为治疗积极性的标志进行了研究。患者进一步分类的保险状况，家庭收入和医院的特点。在12年的研究期间，死亡率下降了8个百分点，而颅内压监测的利用率增加了11个百分点。随着时间的推移，创伤性脑损伤更积极的管理趋势与医院结局的改善相对应。缺乏保险与更糟糕的结果有关。据估计，6，437名儿童因创伤性脑损伤住院治疗而幸存下来，1，418名儿童因未投保而死亡。改善治疗的价值约为170亿美元，而急性护理住院费用增加了15亿美元（按2000年定值美元计算）。没有保险的儿童死亡率增加与37.6亿美元的经济利益损失有关。结论：随着时间的推移，更积极的儿科创伤性脑损伤治疗似乎有助于降低死亡率，挽救了数千人的生命。如果有保险儿童和无保险儿童的死亡率相等，就可以挽救更多的生命。
Objective:This study examines the incidence, utilization of procedures, and outcomes for critically ill children hospitalized with traumatic brain injury over the period 1988–1999 to describe the benefits of improved treatment. Design:Retrospective analysis of hospital discharges was conducted using data from the Health Care Cost and Utilization Project Nationwide Inpatient Sample that approximates a 20% sample of U.S. acute care hospitals. Setting:Hospital inpatient stays from all types of U.S. community hospitals. Participants:The study sample included all children aged 0–21 with a primary or secondary ICD-9-CM diagnosis code for traumatic brain injury and a procedure code for either endotracheal intubation or mechanical ventilation. Interventions:None. Measurements and Main Results:Deaths occurring during hospitalization were used to calculate mortality rates. Use of intracranial pressure monitoring and surgical openings of the skull were investigated as markers for the aggressiveness of treatment. Patients were further classified by insurance status, household income, and hospital characteristics. Over the 12-yr study period, mortality rates decreased 8 percentage points whereas utilization of intracranial pressure monitoring increased by 11 percentage points. The trend toward more aggressive management of traumatic brain injury corresponded with improved hospital outcomes over time. Lack of insurance was associated with vastly worse outcomes. An estimated 6,437 children survived their traumatic brain injury hospitalization because of improved treatment, and 1,418 children died because of increased mortality risk associated with being uninsured. Improved treatment was valued at approximately $17 billion, whereas acute care hospitalization costs increased by $1.5 billion (in constant 2000 dollars). Increased mortality in uninsured children was associated with a $3.76 billion loss in economic benefits. Conclusions:More aggressive management of pediatric traumatic brain injury appears to have contributed to reduced mortality rates over time and saved thousands of lives. Additional lives could be saved if mortality rates could be equalized between insured and uninsured children.
新泽西州的市场改革及其对急性心肌梗死死亡率的影响。
影响因子：
3.4
作者：
Volpp,KevinGM;Williams,SankeyV;Waldfogel,Joel;Silber,JeffreyH;Schwartz,JSanford;Pauly,MarkV
通讯作者：
Pauly,MarkV