The cost of childhood intussusception in Ontario from 2003 to 2016: A population-based study.

BACKGROUND: Management of pediatric intussusception has evolved to favor non-surgical reduction with potential outpatient management. The overall impact of these changes on healthcare costs is unknown. METHODS: A retrospective longitudinal cohort study was conducted utilizing population-based universal-access administrative healthcare data to identify patients <18 years treated for intussusception January 2003-December 2016 in Ontario, Canada. Hospital-associated cost included emergency department and cost of hospitalization, while total cost also included billable physician costs. All costs are presented in 2016 Canadian Dollars. RESULTS: The median hospital-associated costs for each modality were: non-surgical $2467, failed non-surgical $6508, and surgical only $8863 (p < 0.0001). Costs associated with non-surgical or surgical only management did not change over the study period, whereas costs associated with failed non-surgical management increased from $3842 in 2003 to $12,350 in 2016 (p = 0.0003). Similar trends were observed when physician billing data was included. Costs were $1076.95 higher in community hospitals than academic hospitals (95% CI: $344, $1810; p = 0.004). CONCLUSION: The cost of care for intussusception is dependent upon treatment modality and was lowest for non-surgical management and highest for patients treated in community hospitals. Efforts to standardize care to promote successful non-surgical management and to facilitate early discharge could provide cost savings to the healthcare system. TYPE OF STUDY: Cost Effectiveness Study. LEVEL OF EVIDENCE: IV.

Diffusion Tensor Imaging Findings in Post-Concussion Syndrome Patients after Mild Traumatic Brain Injury: A Systematic Review.

OBJECTIVES: To review the evidence for the use of diffusion tensor imaging (DTI) parameters in the human brain as a diagnostic tool for and predictor of post-concussion syndrome (PCS) after a mild traumatic brain injury (mTBI). DESIGN: Systematic review. DATA SOURCES: All relevant studies in AMED, Embase, MEDLINE, Ovid, PubMed, Scopus, and Web of Science through 20 May, 2016. STUDY SELECTION: Studies that analyze traditional DTI measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)] and the severity of PCS symptoms or the development of PCS in humans after an mTBI. DATA EXTRACTION: Population studied, patient source, mTBI diagnosis method, PCS diagnosis method, DTI values measured, significant findings, and correlation between DTI findings and PCS. DATA SYNTHESIS: Ten studies investigated correlations between DTI values and PCS symptom severity or between DTI values and the development of PCS in mTBI patients. Decreased FA and increased MD and RD were associated with the development and severity of PCS. AD was not found to change significantly. Brain regions found to have significant changes in DTI parameters varied from study to study, although the corpus callosum was most frequently cited as having abnormal DTI parameters in PCS patients. CONCLUSION: DTI abnormalities correlate with PCS incidence and symptom severity, as well as indicate an increased risk of developing PCS after mTBI. Abnormal DTI findings should prompt investigation of the syndrome to ensure optimal symptom management at the earliest stages. Currently, there is no consensus in the literature about the use of one DTI parameter in a specific region of the brain as a biomarker for PCS because no definite trends for DTI parameters in PCS subjects have been identified. Further research is required to establish a standard biomarker for PCS.