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Trends in intracranial monitoring for pediatric medically intractable epilepsy: 2000-2012
Tony R Wang1, Russell C Bailey2, Howard P Goodkin2
1From the Departments of Neurologic Surgery (T.R.W., K.B.M.), Neurology (R.C.B., H.P.G.), and Pediatrics (R.C.B., H.P.G.), University of Virginia Health System, Charlottesville, VA. TW5TF@hscmail.mcc.virginia.edu.
Insights
Nationwide, the rate of intracranial monitoring (ICM) for pediatric medically intractable epilepsy (MIE) decreased from 2000-2012. Despite this, ICM increasingly led to epilepsy surgery, though access disparities persist.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Medical Device Utilization
Background:
- Medically intractable epilepsy (MIE) in children presents significant management challenges.
- Intracranial monitoring (ICM) is a crucial diagnostic tool for surgical planning in MIE.
- Understanding trends in ICM utilization is vital for assessing healthcare access and outcomes.
Purpose of the Study:
- To analyze nationwide trends in the utilization of intracranial monitoring (ICM) for pediatric medically intractable epilepsy (MIE) between 2000 and 2012.
- To investigate changes in the proportion of ICM cases leading to resective epilepsy surgery.
- To identify disparities in access to ICM.
Main Methods:
- Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000-2012).
- Identification of MIE and ICM admissions using ICD-9-CM codes.
- Statistical analysis including logistic regression and trend testing (Cochran-Armitage test).
Main Results:
- The overall rate of ICM for pediatric MIE declined from 5.39% to 2.56% despite an increase in total MIE admissions.
- The proportion of ICM cases resulting in resective epilepsy surgery significantly increased from 45.18% to 75.83%.
- Significant disparities in ICM access were observed, with African American individuals and those insured by Medicaid being less likely to undergo the procedure.
Conclusions:
- A significant downward trend in pediatric ICM utilization for MIE was observed nationwide, driven by a rise in MIE admissions.
- ICM is increasingly associated with successful epilepsy surgery, indicating improved patient selection or surgical candidacy.
- Further investigation is needed to understand the reasons behind the declining ICM rates and persistent access disparities.
Objective:
To retrospectively examine nationwide trends in intracranial monitoring (ICM) for pediatric medically intractable epilepsy (MIE) from 2000 to 2012.
Methods:
The Healthcare Cost and Utilization Project Kids' Inpatient Database was analyzed to identify admissions with ICD-9-CM codes corresponding to MIE and ICM from 2000 to 2012, inclusive. Associations between independent variables and outcomes were tested using χ2 test or Fisher exact test. A multivariate logistic regression analysis of variables associated with ICM was completed using stepwise selection. The Cochran-Armitage test was used to test for trend of a variable over the study period.
Results:
The number of ICM procedures increased over the study period; however, secondary to large increases in the number of MIE admissions, the rate of ICM declined from 5.39% in 2000 to 2.56% in 2012 (p < 0.001). Despite this decline, ICM increasingly resulted in resective epilepsy procedures. In 2000, only 45.18% of ICM cases led to resective epilepsy surgery, which increased to 75.83% by 2012 (p < 0.001). ICM complication rates were comparable to, if not lower than, standard resective surgery. Disparities in access to ICM exist, with African American individuals and those with Medicaid significantly less likely to undergo ICM.
Conclusion:
In this nationwide characterization of pediatric ICM trends, we identified a slight, significant downward trend in the rate of utilization of ICM for MIE. This was secondary to substantial increases in the number of hospital admissions for MIE. Reasons for this large increase and why it has not led to increased rates of ICM warrant further investigation.
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