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The Price for Delayed Diagnosis of Pediatric Septic Hip: Increased Cost and Poor Outcomes
Ena Nielsen1, J Alexandra Mortimer2, Viviana Bompadre3
1University of Washington, Seattle, WA.
Insights
Early diagnosis of pediatric septic hip improves outcomes and reduces costs. Delayed treatment leads to longer hospital stays, more complications, and significantly higher healthcare expenses, decreasing overall value.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Health Economics
Background:
- Septic arthritis of the hip in children requires prompt diagnosis and treatment for optimal outcomes.
- Healthcare value is determined by the ratio of outcomes to costs.
- Understanding the value of early versus delayed treatment is critical for managing pediatric septic hip.
Purpose of the Study:
- To evaluate the clinical outcomes associated with early versus delayed treatment of pediatric septic arthritis of the hip.
- To determine the associated healthcare costs and overall value of early versus delayed treatment strategies.
- To identify factors influencing outcomes and costs in pediatric septic hip cases.
Main Methods:
- A retrospective review of pediatric septic hip cases treated between 2011 and 2016 at a single institution.
- Analysis of patient demographics, clinical presentation, treatment details, and follow-up data.
- Comparison of hospital charges between early (<4 days) and delayed (≥4 days) diagnosis groups.
Main Results:
- Delayed diagnosis (≥4 days) was associated with significantly longer hospital stays (17 vs. 9 days) and follow-up periods (56 vs. 19 weeks).
- The delayed group experienced higher rates of long-term complications (50% vs. 3%) and required more interventions, including I&Ds and antibiotic courses.
- Average total hospital costs were substantially higher in the delayed diagnosis group ($243,411) compared to the early diagnosis group ($102,774).
Conclusions:
- Delayed diagnosis of pediatric septic hip leads to poorer clinical outcomes, including increased complications and longer recovery times.
- Higher healthcare utilization and costs are directly linked to delayed diagnosis and treatment of pediatric septic hip.
- Early diagnosis and treatment are essential for improving healthcare value in pediatric septic hip management.
Background:
Most authors agree that early diagnosis and treatment of pediatric septic hip, within 4 days of onset of symptoms, is crucially important for good outcomes. In healthcare, value is a function of outcome over cost. The purpose of this study was to determine the clinical outcome and cost, therefore value, associated with early versus delayed treatment of pediatric septic arthritis of the hip.
Methods:
A retrospective review was performed at a single pediatric hospital. Hospital records over 6 years (2011 to 2016) were examined to identify patients who had undergone treatment for primary septic arthritis of the hip. Patient demographics, clinical data at presentation, treatment information, and follow-up data were recorded. Hospital charges at account level were calculated and compared between groups.
Results:
Forty-three subjects were identified for analysis. Twelve presented more than 4 days after the onset of symptoms (delayed diagnosis). There was no difference in patient demographics, Kocher criteria, or initial imaging performed between those with early versus delayed diagnosis. The delayed group had significantly longer length of hospital stay (17 vs. 9 d, P =0.003), follow-up needed (56 vs. 19 wk P =0.001), long-term complications (50% vs. 3%, P =0.000), duration of antibiotics (8 vs. 5.5 wk, P= 0.043), greater number of I&Ds (2 vs. 1, P =0.04), more tissue cultures and blood draws (6 vs. 2, P =0.002; and 3 vs. 2 P =0.009, respectively) and more radiographs taken as outpatients (4 vs. 2, P =0.001, respectively). The average total hospital charge (inpatient and outpatient) was $102,774 in the early diagnosis group and $243,411 in the delayed group ( P =0.012).
Conclusions:
Delayed diagnosis of pediatric septic hip correlated with longer length of hospital stay, duration of follow-up, and more long-term complications. These factors contributed to higher total hospital costs and therefore decreased healthcare value.
