‘Possible shunt malfunction’ pathway for paediatric hydrocephalus—a study of clinical outcomes and cost implications
| العنوان: | ‘Possible shunt malfunction’ pathway for paediatric hydrocephalus—a study of clinical outcomes and cost implications |
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| المؤلفون: | Atul Tyagi, Louise Higgins, Paul Chumas, John Goodden, Liting Tong, Gnanamurthy Sivakumar |
| المصدر: | Child's Nervous System. 37:499-509 |
| بيانات النشر: | Springer Science and Business Media LLC, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Reoperation, medicine.medical_specialty, Audit, Ventriculostomy, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, Child, Average cost, Retrospective Studies, Third Ventricle, business.industry, Shunt malfunction, Endoscopic third ventriculostomy, Infant, General Medicine, medicine.disease, Triage, Hydrocephalus, Shunt (medical), Treatment Outcome, Neuroendoscopy, Pediatrics, Perinatology and Child Health, Emergency medicine, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery |
| الوصف: | Shunt insertion for hydrocephalus is a common paediatric neurosurgery procedure. Shunt complications are frequent with an estimated 20–40% failure rate within the first year, and 4.5% per year subsequently. We have an open-door ‘possible shunt malfunction’ pathway for children treated with a shunt or endoscopic third ventriculostomy, providing direct ward access to ensure rapid assessment and timely management of children. To audit the ‘possible shunt malfunction’ pathway in terms of clinical outcomes (percentage-confirmed shunt dysfunction and number of re-attendances) and costs. Clinical data for patients attending the triage service were prospectively recorded over 7 months—including the number of attendances, previous shunt revisions, shunt type, investigations performed (CT, x-rays), and outcome. Costings (e.g. costs of physician, inpatient stay, investigations) were obtained from the hospital’s procurement department. In the study period, there were 81 attendances by 62 patients and only 16% of attendances resulted in surgical management (either shunt revision or ETV). Approximately 17% of patients re-attended at least once. The average cost per attendance in our pathway was £765.57 ($969.63; €858.73). The total expenditure for the pathway over 7 months was £62,011.03 ($78,540.07; €69,556.81), with inpatient stay making up the biggest percentage of cost (49.2%). Only 16% (13 attendances) of those attending through our pathway required neurosurgical intervention. Investigations for possible blocked shunt come at significant health, social, and financial cost. High rates of shunt failure, re-attendance, investigations, and inpatient stays incur a sizable financial burden to the healthcare system. |
| تدمد: | 1433-0350 0256-7040 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::811f209519434d59af8c59154d5a0262Test https://doi.org/10.1007/s00381-020-04878-yTest |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....811f209519434d59af8c59154d5a0262 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14330350 02567040 |
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