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Gastrostomy tube insertion in children with developmental or acquired disorders: a register-based study
Ellen Backman1,2, Lotta Sjögreen3,4
1School of Health and Welfare, Halmstad University, Halmstad, Sweden.
Insights
Gastrostomy tube insertions in children increased significantly in Sweden from 1998 to 2014, particularly for those with developmental disorders. Mortality rates were higher in children with acquired disorders, highlighting the need for palliative care considerations.
Area of Science:
- Pediatric Gastroenterology
- Public Health Trends
- Clinical Outcomes Research
Background:
- Gastrostomy tube (GT) insertion is a common procedure for children requiring nutritional support.
- Understanding trends and associated factors in GT insertion is crucial for healthcare planning.
Purpose of the Study:
- To describe trends in gastrostomy tube insertion among children with developmental or acquired disorders in Sweden.
- To assess demographic characteristics and mortality associated with GT insertion in this population.
Main Methods:
- Retrospective analysis of the Swedish National Patient Register (1998-2014).
- Inclusion of children aged 0-18 years undergoing gastrostomy tube insertion.
- Statistical analysis using linear and logistic regression to examine associations between disorder type, age, and mortality.
Main Results:
- Gastrostomy tube insertions increased by 140% between 1998 and 2014.
- Children with developmental disorders, primarily cerebral palsy, constituted the largest group (85%).
- Age at insertion decreased annually; children with developmental disorders were younger at insertion than those with acquired disorders. Mortality was higher in the acquired disorders group.
Conclusions:
- Significant increase in pediatric gastrostomy tube insertions observed, with younger insertion ages over time.
- Distinct demographic profiles and outcomes exist for children with developmental versus acquired disorders.
- Gastrostomy tube insertion in children with acquired disorders warrants consideration within a palliative care framework.
Aim:
To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics.
Method:
Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis.
Results:
The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1-8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased in both groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach.
Interpretation:
Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion.
What This Paper Adds:
Gastrostomy tube insertions increased by 140% from 1998 to 2014 in Sweden. The age of children with developmental disorders decreased by 1 month per year during the study period. Children presenting with developmental disorders were younger than children with acquired disorders when the gastrostomy tube was first inserted. Mortality was higher in children with acquired disorders.
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