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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurocognitive predictors of length of stay within a children's psychiatric inpatient program
Brian Kavanaugh1, Jane Studeny2, Mary Kathryn Cancilliere3
1Department of Psychiatry & Human Behavior, E. P. Bradley Hospital/Alpert Medical School of Brown University, East Providence, RI, USA.
Insights
Neurocognitive deficits, particularly in executive functioning and construction, predict longer hospital stays for children in psychiatric programs. Early identification of these impairments can help manage length of stay (LOS).
Area of Science:
- Child and Adolescent Psychiatry
- Neuropsychology
- Healthcare Management
Background:
- Length of stay (LOS) in pediatric psychiatric inpatient settings is influenced by various factors.
- Neurocognitive functioning is a critical area that may impact treatment duration and outcomes.
- Understanding these predictors is essential for optimizing resource allocation and patient care.
Purpose of the Study:
- To identify neurocognitive predictors of LOS in children aged 6-14 undergoing psychiatric hospitalization.
- To compare the efficacy of Global Deficit Score (GDS) and standard composite score approaches in predicting LOS.
- To determine if neurocognitive impairments significantly influence the duration of psychiatric inpatient stays.
Main Methods:
- A retrospective chart review of 96 children (aged 6-14) who received neuropsychological evaluations during hospitalization.
- Correlation and linear regression analyses were used to assess the relationship between neurocognitive domains (memory, construction, executive functioning, IQ) and LOS.
- Both Global Deficit Score (GDS) and standard mean composite scores were utilized to quantify neurocognitive impairment.
Main Results:
- Overall neurocognition, executive functioning (EF), and construction abilities were significantly associated with LOS using both GDS and composite score methods.
- After controlling for clinical and demographic factors, GDS-Total, GDS-EF/Construction, and EF/Construction composite scores remained significant predictors of LOS.
- Receiver operating characteristic (ROC) curve analysis indicated that the GDS could effectively distinguish between prolonged and non-prolonged hospitalizations.
Conclusions:
- Neurocognitive impairments, especially in executive functioning and construction, are significant predictors of longer length of stay in pediatric psychiatric inpatient programs.
- Both GDS and composite score approaches are effective in identifying neurocognitive impairments and their association with LOS.
- These findings highlight the importance of comprehensive neuropsychological evaluations in predicting and managing LOS for improved patient outcomes.
Abstract:
This study investigated the neurocognitive predictors of length of stay (LOS) within a children's psychiatric inpatient program. A medical chart review was conducted for 96 children aged 6-14 years who received a neuropsychological evaluation during hospitalization. Correlation and linear regression analyses examined the influence of neurocognition (memory, construction, executive functioning [EF], and intelligence [IQ]) on subsequent LOS. Impairment/performance was calculated by the standard mean composite score and global deficit score (GDS) approaches for each domain and for overall neurocognition. Rates of impairment were similar between the two approaches (ranging from 22.9% to 45.8% across domains). Overall neurocognition (r = .347 & -.270, respectively), EF (r = .333 & -.261, respectively), and construction (r = .287 & -.240), respectively, were significantly associated with LOS utilizing the GDS and composite approaches. After controlling for clinical/demographic predictors of LOS, GDS-Total, GDS-EF/Construction, and EF/Construction composite scores significantly predicted LOS. Further, receiver operating characteristic (ROC) curve detected the GDS was able to distinguish between those children that would and would not end up having a prolonged hospitalization. The GDS and composite score approaches to neurocognitive impairment detection were similarly able to capture neurocognitive impairment and the association of impairment to LOS within a children's psychiatric inpatient program.
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