Hospital care for children with hydrocephalus in the United States: resource utilization, charges, comorbidities, and deaths (2006–2019)
Bibliographic record
Abstract
OBJECTIVE: The authors provide an updated analysis of inpatient healthcare utilization, associated costs, and mortality trends for pediatric hydrocephalus in the US from 2006 to 2019. The goals were to describe patient, hospital, and hospitalization characteristics and determine factors associated with mortality. METHODS: This cross-sectional study used 2006, 2009, 2012, 2016, and 2019 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, which collects nationally representative weighted data samples of pediatric hospital discharges. Admissions related to hydrocephalus were categorized as being associated with permanent cerebrospinal fluid (CSF) diversion (including CSF shunt management and endoscopic third ventriculostomy [ETV] with or without choroid plexus cauterization [CPC]) or unrelated to permanent CSF diversion. RESULTS: Each year, there were approximately 30,000-32,000 hydrocephalus-related admissions, resulting in 331,000-526,000 hospital days and US$3.4-5.0 billion charges, for pediatric patients. In 2019, hydrocephalus accounted for 0.5% of all pediatric hospital admissions, 1.4% of all pediatric hospital days, and 2.4% of all pediatric hospital charges in the US. The median (IQR) length of stay across all hydrocephalus-related admissions decreased from 4 (2-15) days in 2006 to 3 (2-9) days in 2019. CSF shunt-related admissions decreased from 11,111 in 2006 to 7959 in 2016; notably, admissions for CSF shunt malfunctions/revisions decreased over time (12,327 in 2006 to 5960 in 2019). In 2019, hospital stays were shorter (4.99 vs 6.69 days) and charges were lower (US$108 million vs US$128 million) in patients who underwent ETV or ETV+CPC compared to those who had initial shunt placement, respectively. However, these unadjusted differences likely reflect baseline patient selection rather than inherent procedural superiority. Patients admitted for periventricular-intraventricular hemorrhage of prematurity (pIVH) had longer hospital stays (p < 0.001) and higher mean costs than others. Compared with survivors, children who died were younger, had pIVH, had a birth-related admission, were self-paying, and were admitted to a nonchildren's hospital (p < 0.05). CONCLUSIONS: Pediatric hydrocephalus continues to pose a heavy burden in the US. Despite advancements in management, it remains associated with high costs, significant hospital utilization, and substantial morbidity and mortality. ETV admissions were associated with shorter hospital stays and lower costs, and pIVH was associated with particularly high resource utilization and markedly higher in-hospital mortality. Future efforts should focus on reducing mortality and improving care delivery for high-risk subgroups, particularly those with pIVH and birth-related etiologies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".