Temporal Trends of Pediatric Hospitalizations with Acute Disseminated Encephalomyelitis in the United States: An...

Area of Science:

• Neurology
• Pediatrics
• Epidemiology

Background:

• Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated inflammatory demyelinating disease of the central nervous system.
• Understanding temporal trends in ADEM epidemiology and hospitalization outcomes is crucial for public health planning and resource allocation.

Purpose of the Study:

• To analyze temporal trends in the incidence of pediatric acute disseminated encephalomyelitis (ADEM) hospitalizations in the United States between 2006 and 2014.
• To evaluate changes in hospitalization outcomes, including mortality, length of stay, and cost, associated with ADEM during the study period.

Main Methods:

• Utilized the National (Nationwide) Inpatient Sample (NIS) database to identify pediatric hospitalizations (≤18 years) with an ADEM diagnosis from 2006 to 2014.
• Employed statistical analysis to examine trends in ADEM incidence by age, sex, race, and region, and analyzed outcomes such as mortality, length of stay (LOS), and hospitalization costs.
• Applied sampling weights from the NIS to generate national estimates and considered a P-value < .05 as statistically significant.

Main Results:

• The overall incidence of ADEM-associated pediatric hospitalizations was 0.5 per 100,000 population, with a significant increase from 0.4 to 0.6 per 100,000 between 2006-2008 and 2012-2014 (P-trend < .001).
• Black and Hispanic children exhibited a significantly increased incidence of ADEM. The majority of hospitalizations (67%) were in children under 9 years old, with no significant sex preponderance.
• While mortality and median length of stay (4.8-5.5 days) remained stable, the inflation-adjusted median cost of hospitalization significantly increased from $11,594 to $16,193 between the two periods (P-trend = .002).

Conclusions:

• The incidence of pediatric ADEM hospitalizations in the US has risen between 2006 and 2014.
• Hospitalization outcomes for ADEM, specifically mortality and length of stay, have remained consistent over the study period.
• Despite stable clinical outcomes, the economic burden of ADEM hospitalizations has significantly increased, necessitating attention to healthcare costs.