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Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia.
Akbari, Syed Hassan A; Rizvi, Asad A; CreveCoeur, Travis S; Han, Rowland H; Greenberg, Jacob K; Torner, James; Brockmeyer, Douglas L; Wellons, John C; Leonard, Jeffrey R; Mangano, Francesco T; Johnston, James M; Shah, Manish N; Iskandar, Bermans J; Ahmed, Raheel; Tuite, Gerald F; Kaufman, Bruce A; Daniels, David J; Jackson, Eric M; Grant, Gerald A; Powers, Alexander K; Couture, Daniel E; Adelson, P David; Alden, Tord D; Aldana, Philipp R; Anderson, Richard C E; Selden, Nathan R; Bierbrauer, Karin; Boydston, William; Chern, Joshua J; Whitehead, William E; Dauser, Robert C; Ellenbogen, Richard G; Ojemann, Jeffrey G; Fuchs, Herbert E; Guillaume, Daniel J; Hankinson, Todd C; O'Neill, Brent R; Iantosca, Mark; Oakes, W Jerry; Keating, Robert F; Klimo, Paul; Muhlbauer, Michael S; McComb, J Gordon; Menezes, Arnold H; Khan, Nickalus R; Niazi, Toba N; Ragheb, John; Shannon, Chevis N; Smith, Jodi L; Ackerman, Laurie L.
Afiliación
  • Akbari SHA; 1Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
  • Rizvi AA; Departments of2Neurological Surgery and.
  • CreveCoeur TS; Departments of2Neurological Surgery and.
  • Han RH; Departments of2Neurological Surgery and.
  • Greenberg JK; Departments of2Neurological Surgery and.
  • Torner J; 4Department of Epidemiology, University of Iowa, Iowa City, Iowa.
  • Brockmeyer DL; 5Department of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah.
  • Wellons JC; 6Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Leonard JR; 7Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
  • Mangano FT; 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Johnston JM; 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama.
  • Shah MN; 10Department of Pediatric Surgery and Neurosurgery, The University of Texas McGovern Medical School, Houston, Texas.
  • Iskandar BJ; 11Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
  • Ahmed R; 11Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
  • Tuite GF; 12Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, Florida.
  • Kaufman BA; 13Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
  • Daniels DJ; 14Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
  • Jackson EM; 15Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
  • Grant GA; 16Department of Neurosurgery, Stanford Child Health Research Institute, Stanford, California.
  • Powers AK; 17Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
  • Couture DE; 17Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
  • Adelson PD; 18Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
  • Alden TD; 19Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
  • Aldana PR; 20Department of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida.
  • Anderson RCE; 21Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
  • Selden NR; 22Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon.
  • Bierbrauer K; 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Boydston W; 23Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia.
  • Chern JJ; 23Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia.
  • Whitehead WE; 24Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
  • Dauser RC; 24Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
  • Ellenbogen RG; 25Department of Neurosurgery, University of Washington Medicine, Seattle, Washington.
  • Ojemann JG; 25Department of Neurosurgery, University of Washington Medicine, Seattle, Washington.
  • Fuchs HE; 26Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina.
  • Guillaume DJ; 27Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota.
  • Hankinson TC; 28Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado.
  • O'Neill BR; 28Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado.
  • Iantosca M; 1Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
  • Oakes WJ; 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama.
  • Keating RF; 29Department of Neurosurgery, Children's National Medical Center, Washington, DC.
  • Klimo P; 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
  • Muhlbauer MS; 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
  • McComb JG; 31Division of Neurosurgery, Children's Hospital Los Angeles, California.
  • Menezes AH; 32Department of Neurosurgery, University of Iowa Hospitals, Iowa City, Iowa.
  • Khan NR; 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida.
  • Niazi TN; 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida.
  • Ragheb J; 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida.
  • Shannon CN; 6Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Smith JL; 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
  • Ackerman LL; 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
J Neurosurg Pediatr ; 29(3): 288-297, 2022 Mar 01.
Article en En | MEDLINE | ID: mdl-34861643
OBJECTIVE: The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM). METHODS: The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes. RESULTS: A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively). CONCLUSIONS: Socioeconomic and demographic factors appear to influence the presentation and management of patients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Diagnostic_studies / Prognostic_studies Idioma: En Revista: J Neurosurg Pediatr Asunto de la revista: NEUROCIRURGIA / PEDIATRIA Año: 2022 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Diagnostic_studies / Prognostic_studies Idioma: En Revista: J Neurosurg Pediatr Asunto de la revista: NEUROCIRURGIA / PEDIATRIA Año: 2022 Tipo del documento: Article