Posts tagged: Elizabeth Perkins

Elizabeth Perkins, ’10

Perkins, E., Stephens, J., Xiang, H., & Lo, W. (2009). The Cost of Pediatric Stroke Acute Care in the United States. Stroke, 40(8), 2820-2827.

Abstract: Background and Purpose–The cost of pediatric stroke care has received little attention, but the available data suggest it is expensive. To determine the cost of acute stroke, we analyzed a US national database.Method–We used the Kids’ Inpatient Database (KID2003) to determine the hospital-based costs of acute stroke in children ages 3 months to 20 years. Discharges were selected if the first diagnostic position contained an International Classification of Diseases, 9th Revision code pertaining to ischemic or hemorrhagic stroke. We examined the relationship between cost and stroke type by adjusting for variables that predict the cost of adult stroke.Results–There were 2224 pediatric cases, after statistical weighting, discharged with a diagnosis of hemorrhagic or ischemic stroke in KID2003. The estimated cost of acute pediatric stroke in the United States was $42 million in 2003. For the entire cohort, the mean cost of acute hospital care was $20 927 per discharge. The mean cost for ischemic stroke was $15 003, for intracerebral hemorrhage $24 117, and for subarachnoid hemorrhage $31 653. Stroke diagnosis, length of stay, hospital ownership, rural/urban teaching status, US geographical region, and discharge disposition were significantly associated with cost. Cost remained significantly associated with stroke diagnosis after adjusting for other predictors in the final multivariable regression model.Conclusions–Pediatric stroke is expensive, and the lifetime cost of care is likely greater for a child than an adult. The cost to the family and the larger society underscore the importance of pediatric stroke treatment and prevention.

Elizabeth Perkins, ’10

Lo, W. D., Lee, J., Rusin, J., Perkins, E., & Roach, E. S. (2008). Intracranial Hemorrhage in Children: An Evolving Spectrum. Archives of Neurology, 65(12), 1629-1633.

Abstract: BACKGROUND: Nontraumatic intracranial hemorrhages (ICHs) are uncommon in children, but are important causes of death and injury. OBJECTIVES: To determine whether the risk factors for ICH have changed compared with those in earlier published series and to estimate the residual deficits in the survivors. DESIGN, SETTING, AND PATIENTS: We performed a retrospective review of patients admitted to a single tertiary care, academic pediatric hospital from January 1, 2000, through May 31, 2007. Records were retrieved if the diagnostic codes from the International Classification of Diseases, Ninth Revision, were pertinent to ICHs. We searched reports from computed tomograms and magnetic resonance images of the brain for terms pertaining to ICH. MAIN OUTCOME MEASURES: Risk factors and functional outcome. Secondary measures were hemorrhage type and clinical presentation. RESULTS: We identified 85 children who had nontraumatic ICH. There were 10 subarachnoid, 61 intracerebral, and 14 subdural hemorrhages. Intracranial vascular anomalies were the most frequent risk factor, followed by congenital heart disease and brain tumors. Arteriovenous malformations did not account for as large a percentage as in previous studies. Twenty-nine children died. Of the 48 survivors for whom follow-up information was available, 26 had no reported deficits and 22 had deficits ranging from mild to severe. CONCLUSIONS: In this series, brain tumors and congenital heart disease accounted for a greater proportion of ICHs than in previous studies. The mortality due to ICH remains high but may be related as much to the severity of the underlying illnesses as to the hemorrhage itself. We found significant long-term morbidity, but more than half of the survivors for whom follow-up data were available had no detectable deficits. A long-term outcome study of pediatric ICH is needed.

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