Elsevier

The Journal of Pediatrics

Volume 206, March 2019, Pages 26-32.e1
The Journal of Pediatrics

Original Articles
Temporal Trends of Pediatric Hospitalizations with Acute Disseminated Encephalomyelitis in the United States: An Analysis from 2006 to 2014 using National Inpatient Sample

https://doi.org/10.1016/j.jpeds.2018.10.044Get rights and content

Objective

To determine the temporal trends in the epidemiology of acute disseminated encephalomyelitis (ADEM) and hospitalization outcomes in the US from 2006 through 2014.

Study design

Pediatric (≤18 years of age) hospitalizations with ADEM discharge diagnosis were identified from the National (Nationwide) Inpatient Sample (NIS) for years 2006 through 2014. Trends in the incidence of ADEM with respect to age, sex, race, and region were examined. Outcomes of ADEM in terms of mortality, length of stay (LOS), cost of hospitalization, and seasonal variation were analyzed. NIS includes sampling weight. These weights were used to generate national estimates. P value  of < .05 was considered significant.

Results

Overall incidence of ADEM associated pediatric hospitalizations from 2006 through 2014 was 0.5 per 100 000 population. Between 2006 through 2008 and 2012 through 2014, the incidence of ADEM increased from 0.4 to 0.6 per 100 000 (P-trend <.001). Black and Hispanic children had a significantly increased incidence of ADEM during the study period (0.2-0.5 per 100 000 population). There was no sex preponderance and 67% of ADEM hospitalizations were in patients <9 years old. From 2006 through 2008 to 2012 through 2014 (1.1%-1.5%; P-trend 0.07) and median LOS (4.8-5.5 days; Ptrend = .3) remained stable. However, median inflation adjusted cost increased from $11 594 in 2006 through 2008 to $16 193 in 2012 through 2014 (Ptrend = .002).

Conclusion

In this large nationwide cohort of ADEM hospitalizations, the incidence of ADEM increased during the study period. Mortality and LOS have remained stable over time, but inflation adjusted cost of hospitalizations increased.

Section snippets

Methods

National (Nationwide) Inpatient Sample (NIS) databases from the years 2006-2014 were used to derive our study population. NIS is one of a family of databases and software tools developed for the Healthcare Cost and Utilization Project (HCUP) that is sponsored by Agency for Healthcare Research and Quality.14 NIS database contains inpatient data including clinical and resource use information derived from billing data submitted by hospitals to statewide data organizations across US. The 2014 NIS

Results

We identified a total of 55 667 114 pediatric hospitalizations within the NIS between 2006 and 2014 of which 3319 had an ADEM diagnosis with International Classification of Diseases, Ninth Revision, Clinical Modification code 323.61. Of the total ADEM cases identified, ADEM was the primary diagnosis in 73 cases and the secondary diagnosis in 3246 cases. The overall incidence of ADEM for the study period was 0.5 per 100 000 children/year. Table I describes the baseline and demographic

Discussion

In this analysis using the NIS, a large nationally representative database of inpatient hospitalizations in the US, we have demonstrated upward trends in the incidence of ADEM-associated pediatric hospitalizations in the US from 2006 to 2014. Upward trends of incidence were seen across all age groups with peak incidence at age 2 years. Increased incidence also was seen in black and Hispanic children, and across all regions of the US except the Northeast. Seasonal variation was observed, with

Data Statement

Data sharing statement available at www.jpeds.com.

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      As with other central nervous system demyelinating diseases, there are few data on ADEM incidence—a disorder most common in children—in the literature, primarily due to difficulties in making the diagnosis [35]. A retrospective review of the NIS (2006–2014) reported a pediatric (≤18y) hospitalization rate of 0.5/100,000, with no difference between males and females (Supplemental Table 6) [35]. A California study (1991–2000) determined rates by age strata: 0.4/100,000 in children < 20y (0.6/100,000 in children 0–4y and 0.8/100,000 in children 5–9y) [36].

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    The authors declare no conflict of interest.

    Portions of this study were presented as a poster at the American Academy of Pediatrics National Conference and Exhibition, November 2-6, 2018, Orlando, Florida.

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