Acute Pediatric Stroke

Abstract

Background and Purpose— Recent studies examined the overall cost of pediatric stroke, but there are little data regarding the sources of these costs. We examined an administrative database that collected charges from 24 US children's hospitals to determine the sources of costs for acute hospital care of stroke. Methods— We used International Classification of Diseases, 9th Revision codes to search the Pediatric Health Information System. From 2003 to 2009 there were 1667 patients who had a primary diagnosis of stroke, 703 of which were hemorrhagic and 964 were ischemic. Individual costs, excluding physician charges, were gathered under 7 categories that were ranked to determine which contributed the most to total cost. Individual costs were ranked within their categories. We analyzed costs based on stroke type. Total costs were adjusted using the US Consumer Price Index to compare increases with the rate of inflation. Results— Median total cost for any stroke was $19 548 (interquartile range, $10 764–$40 721). The category “other/nursing” contributed the most to hospital costs followed by imaging, laboratory, and pharmacy. Brain MRI and CT contributed the most to imaging costs. Hemorrhagic strokes (median $24 843) were more expensive than ischemic strokes (median $16 954). Total cost increased from 2003 to 2009, but no overall annual trend emerged after controlling for gender, age, race, and hospital. Conclusions— This is the first in-depth analysis of cost for pediatric stroke care. The highest cost categories are potential targets for cost containment but are also crucial for effective diagnosis and treatment. Necessary yet prudent use of imaging technologies and inpatient stays may be strategies for cost containment.