A prospective study of diagnostic testing and hospital charges after brief resolved unexplained event

To evaluate diagnostic testing frequency/yield and determine drivers of hospital charges in a prospective cohort of infants with brief resolved unexplained event (BRUE) to test the hypothesis that length of stay (LOS), low-yield diagnostic testing, and repeat hospital visits increase costs.

We conducted a prospective cohort study of infants admitted after BRUE to determine how clinical practice impacts the cost of care. Charge data from our institution's billing records database included room and board, diagnostics, medications, and professional fees for index hospitalizations and 6-month follow-ups. Charts were reviewed for clinical data, testing results, and repeat hospitalizations. Parent-reported symptoms and management changes were obtained by questionnaires. Multivariable analyses with linear regression were conducted to determine risk factors for hospitalization charges and total charges including hospitalization and 6-month follow-up.

The cohort included 155 subjects with median index hospitalization charges of $11,256 and total charges of $15,675. Overall, 76% had persistent BRUE symptoms and 15% repeat hospitalization; 34% were treated with acid suppression. Only 9.7% of the tests performed provided a potential diagnosis, but the videofluoroscopic swallow study (VFSS) had the highest yield with 70% abnormal. On multivariable analysis, LOS, VFSS, flexible laryngoscopy, electroencephalogram, and repeat hospital visits were all associated with increased charges (fold change: 142%-354%).

Hospitalization and follow-up care are costly after BRUE. Potentially modifiable drivers of charges include test number, LOS, and repeat hospital visits. Most testing is low-yield, but timely performance of VFSS may allow for cost-effective and appropriate treatment of oropharyngeal dysphagia and prevention of persistent symptoms. Gastroenterologists are frequently involved in caring for these children and are uniquely positioned to help guide testing and treatment related to gastroesophageal reflux disease and oropharyngeal dysphagia.