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Bommineni VM, Bommineni VL, Gupta R. Quantified trends in provider reimbursement and utilization volume in colorectal cancer screenings: analysis of Medicare claims from 2000 to 2019. Colorectal Dis 2024; 26:1028-1037. [PMID: 38581083 DOI: 10.1111/codi.16971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/05/2023] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
AIM Colorectal cancer (CRC) screening rates in the United States remain persistently below guideline targets, partly due to suboptimal patient utilization and provider reimbursement. To guide long-term national utilization estimates and set reasonable screening adherence targets, this study aimed to quantify trends in utilization of and reimbursement for CRC screenings using Medicare claims. METHOD Inflation-adjusted reimbursements and utilization volume associated with each CRC screening code were abstracted from Medicare claims between 2000 and 2019. Screenings, screenings/100 000 enrolees and reimbursement/screening were analysed with linear regression and compared with the equality of slopes tests. Average reimbursement per screening was compared using analysis of variance with Dunnett's T3 multiple comparisons test. RESULTS The growth rate of multitarget stool DNA tests (mt-sDNA)/100 000 was the highest at 170.4 screenings/year (R2 = 0.99, p ≤ 0.001), while that of faecal occult blood tests/100 000 was the lowest at -446.4 screenings/year (R2 = 0.90, p ≤ 0.001) (p ≤ 0.001). Provider reimbursements averaged $546.95 (95% CI $520.12-$573.78) per mt-sDNA screening, significantly higher than reimbursements for all invasive screenings. Only FOBTs significantly increased in reimbursement per screening at $0.62/year (R2 = 0.91, p ≤ 0.001). CONCLUSION We derived forecastable trend numbers for utilization and provider reimbursement. Faecal immunochemical tests/100 000 and mt-sDNA screenings/100 000 increased most rapidly during the entire study period. The number of nearly all invasive screenings/100 000 decreased rapidly; the number of colonoscopies/100 000 increased slightly, probably due to superior diagnostic strength. These trends indicate the that replacement of other invasive modalities with accessible noninvasive screenings will account for much of future screening behaviour and thus reductions in CRC incidence and mortality, especially given providers' reimbursement incentive to screen average-risk patients with stool-based tests.
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Affiliation(s)
| | | | - Rohan Gupta
- Norton College of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA
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Goshgarian G, Sorourdi C, May FP, Vangala S, Meshkat S, Roh L, Han MA, Croymans DM. Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2146863. [PMID: 35119462 PMCID: PMC8817202 DOI: 10.1001/jamanetworkopen.2021.46863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Importance Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%. Objective To determine whether an electronic primer message delivered through the patient portal increases the completion rate of CRC screening in a mailed fecal immunochemical test (FIT) outreach program. Design, Setting, and Participants In this randomized clinical quality improvement trial at the University of California, Los Angeles Health of 2339 patients enrolled in a FIT mailing program from August 28, 2019, to September 20, 2020, patients were randomly assigned to either the control or intervention group, and the screening completion rate was measured at 6 months. Participants were average-risk managed care patients aged 50 to 75 years, with a valid mailing address, no mailed CRC outreach in the previous 6 months, and an active electronic health record (EHR) patient portal who were due for CRC screening. Data were analyzed on an intention-to-treat basis. Interventions Eligible patients were randomly assigned to receive either (1) the standard FIT mailed outreach (control group) or (2) the standard FIT mailed outreach plus an automated primer to notify patients of the upcoming mailed FIT sent through the electronic patient portal (intervention group). Main Outcomes and Measures The primary outcome was the screening completion rate (ie, returning the FIT). Secondary outcomes were (1) were the time to CRC screening from the FIT mailing date, (2) screening modality completed, and (3) the effect of opening the electronic primer on screening completion rate. Results The study included 2339 patients (1346 women [57.5%]; mean [SD] age, 58.9 [7.5] years). The screening completion rate was higher in the intervention group than in the control group (37.6% [445 of 1182] vs 32.1% [371 of 1157]; P = .005). The time to screening was shorter in the intervention group than in the control group (adjusted hazard ratio, 1.24; 95% CI, 1.08-1.42; P = .003). The proportion of each screening test modality completed was similar in both groups. In a subanalysis of the 900 of 1182 patients (76.1%) in the intervention group who opened the patient portal primer message, there was a 7.3-percentage point (95% CI, 2.3-12.4 percentage points) increase in CRC screening (local mean treatment effect; P = .004). Conclusions and Relevance Implementation of an electronic patient portal primer message in a mailed FIT outreach program led to a significant increase in CRC screening and improvement in the time to screening completion. The findings provide an evidence base for additional refinements to mailed FIT outreach quality improvement programs in large health systems. Trial Registration ClinicalTrials.gov Identifier: NCT05115916.
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Affiliation(s)
- Gregory Goshgarian
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Medicine, Central Michigan University College of Medicine, Mount Pleasant
| | - Camille Sorourdi
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Division of Gastroenterology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Sitaram Vangala
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sarah Meshkat
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Lily Roh
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Maria A Han
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Medicine Quality, University of California, Los Angeles, Los Angeles
| | - Daniel M Croymans
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Medicine Quality, University of California, Los Angeles, Los Angeles
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Limburg PJ, Finney Rutten LJ, Ozbay AB, Kisiel J, Parton M. Recent trends in colorectal cancer screening methods based on Medicare claims data. Curr Med Res Opin 2021; 37:605-607. [PMID: 33476244 DOI: 10.1080/03007995.2021.1879754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite the availability of multiple screening modalities for early detection of colorectal cancer (CRC), participation rates remain well below guideline recommendation goals in the United States. This study analyzed and compared recent national trends in utilization of CRC screening modalities using Medicare claims data. METHOD Medicare claims data for CRC screening during 2014-2018 were aggregated and analyzed by CPT code frequency. Changes in CRC screening test frequencies during the analysis period were measured via generalized linear models and analysis of compound annual growth rates (CAGRs). RESULTS Utilization of the mt-sDNA test increased significantly over time (from 2481 claims in 2014 to 335,455 claims in 2018; p < .001), in contrast to the other analyzed CRC screening tests. The CAGR was higher for mt-sDNA (166.81%) than for COL (0.52%), FOBT (-11.75%), and FIT (0.67%). CONCLUSIONS Utilization of the mt-sDNA test for average-risk CRC screening has increased rapidly since its approval in 2014. These data support growing patient and provider interest in the mt-sDNA test as a non-invasive option for average-risk CRC screening.
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Affiliation(s)
- Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | - John Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Soriano CT, McGarrity TJ, Zhu J, Loloi J, Peiffer LP, Cooper J. An Electronic Questionnaire to Survey Colorectal Cancer Screening Status and Identify High-Risk Cohorts in Large Health Care Organizations. Am J Med Qual 2020; 36:163-170. [PMID: 32605378 DOI: 10.1177/1062860620937236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Though improved screening practices have reduced the incidence and mortality of colorectal cancer (CRC), screening rates continue to be suboptimal. This is especially true of high-risk individuals, who are difficult for clinicians to identify during a typical health care encounter. The authors developed an electronic patient questionnaire that determined an individual's CRC screening status and identified high-risk individuals. The questionnaire was administered to employees through the Department of Human Resources. The response rate was 44.7%; 81.2% of respondents aged ≥50 years were up-to-date on CRC screening; 878 high-risk individuals were identified, 77.7% of whom were up-to-date on CRC screening. However, among high-risk individuals aged 40 to 49 years, only 45.8% reported up-to-date CRC screening. The questionnaire was effective in measuring CRC screening rates and identifying high-risk individuals. Dissemination by the Department of Human Resources was novel, effective, and was not dependent on a health care encounter to assess screening or high-risk status.
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Affiliation(s)
- Christopher T Soriano
- Penn State Milton S. Hershey Medical Center, Hershey, PA Penn State Cancer Institute, Hershey, PA Pennsylvania State University College of Medicine, Hershey, PA
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Alsayid M, Singh MH, Issaka R, Laleau V, Day L, Lee J, Allison J, Somsouk M. Yield of Colonoscopy After a Positive Result From a Fecal Immunochemical Test OC-Light. Clin Gastroenterol Hepatol 2018; 16:1593-1597.e1. [PMID: 29660528 PMCID: PMC6151285 DOI: 10.1016/j.cgh.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/14/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about its ability to detect CRC in large average-risk populations. METHODS We performed a retrospective cohort study of patients (50-75 years old) in the San Francisco Health Network who were screened for CRC by OC-Light FIT from August 2010 through June 2015. Patients with a positive result were referred for colonoscopy. We used electronic health records to identify participants with positive FIT results, and collected results from subsequent colonoscopies and pathology analyses. The FIT positive rate was calculated by dividing the number of positive FIT results by the total number of FIT tests completed. The primary outcome was the positive rate from OC-Light FIT and yield of neoplasms at colonoscopy. Secondary outcomes were findings from first vs subsequent rounds of testing, and how these varied by sex and race. RESULTS We collected result from 35,318 FITs, performed on 20,886 patients; 2930 patients (8.3%) had a positive result, and 1558 patients completed the follow-up colonoscopy. A positive result from the FIT identified patients with CRC with a positive predictive value of 3.0%, and patients with advanced adenoma with a positive predictive value of 20.8%. The FIT positive rate was higher during the first round of testing (9.4%) compared to subsequent rounds (7.4%) (P < .01). The yield of CRC in patients with a positive result from the first round of the FIT was 3.7%, and decreased to 1.8% for subsequent rounds (P = .02). CONCLUSIONS In a retrospective analysis of patients in a diverse safety-net population who underwent OC-Light FIT for CRC screening, we found that approximately 3% of patients with a positive result from a FIT to have CRC and approximately 21% to have advanced adenoma.
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Affiliation(s)
- Muhammad Alsayid
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | | | - Rachel Issaka
- Clinical Research & Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Victoria Laleau
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Lukejohn Day
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Jeffrey Lee
- Kaiser Permanente Division of Research, Vallejo, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - James Allison
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Kaiser Permanente Division of Research, Vallejo, California
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California.
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Coronado GD, Petrik AF, Vollmer WM, Taplin SH, Keast EM, Fields S, Green BB. Effectiveness of a Mailed Colorectal Cancer Screening Outreach Program in Community Health Clinics: The STOP CRC Cluster Randomized Clinical Trial. JAMA Intern Med 2018; 178:1174-1181. [PMID: 30083752 PMCID: PMC6142956 DOI: 10.1001/jamainternmed.2018.3629] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Approximately 24 million US individuals receive care at federally qualified health centers, which historically have low rates of colorectal cancer screening. The US Preventive Services Task Force recommends routine colorectal cancer screening for individuals aged 50 to 75 years. OBJECTIVE To determine the effectiveness of an electronic health record (EHR)-embedded mailed fecal immunochemical test (FIT) outreach program implemented in health centers as part of standard care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized pragmatic clinical trial was conducted in 26 federally qualified health center clinics, representing 8 health centers in Oregon and California, randomized to intervention (n = 13) or usual care (n = 13). All participants were overdue for colorectal cancer screening during the accrual interval (February 4, 2014 to February 3, 2015). INTERVENTIONS Electronic health record-embedded tools to identify eligible adults and to facilitate implementation of a stepwise mailed intervention involving (1) an introductory letter, (2) a mailed FIT, and (3) a reminder letter; training, collaborative learning, and facilitation through a practice improvement process. MAIN OUTCOMES AND MEASURES Effectiveness was measured as clinic-level proportions of adults who completed a FIT, and secondarily, any colorectal cancer screening within 12 months of accrual or by August 3, 2015. Implementation was measured as clinic-level proportions of adults who were mailed an introductory letter and ordered a FIT. RESULTS Twenty-six clinics with 41 193 adults (mean [SD] age, 58.5 [6.3] years; 22 994 women) were randomized to receive the direct mail colorectal screening intervention (13 clinics; 21 134 patients) or usual care (13 clinics; 20 059 patients). Compared with usual care clinics, intervention clinics had significantly higher adjusted clinic-level proportion of participants who completed a FIT (13.9% vs 10.4%; difference, 3.4 percentage points; 95% CI, 0.1%-6.8%) and any colorectal cancer screening (18.3% vs 14.5%; difference, 3.8 percentage points; 95% CI, 0.6%-7.0%). We observed large variation across health centers in effectiveness (FIT completion differences range, -7.4 percentage points to 17.6 percentage points) and implementation (proportion who were mailed a FIT range, 6.5% to 68.2%). The number needed to mail to achieve a completed FIT was 4.8 overall, and 4.0 in clinics that mailed a FIT reminder. CONCLUSIONS AND RELEVANCE An EHR-embedded mailed FIT outreach intervention significantly improved rates of FIT completion and rates of any colorectal cancer screening. Higher rates of colorectal cancer screening occurred in clinics that successfully implemented the mailed outreach program. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01742065.
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Affiliation(s)
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Stephen H Taplin
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - Erin M Keast
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Abstract
PURPOSE OF REVIEW The goal of this review is to summarize stool-based testing for colorectal cancer (CRC). The key questions answered in this review were the advantages and limitations of each available stool-based test for CRC and to examine their comparative efficacy. RECENT FINDINGS Guaiac-based fecal occult blood testing (gFOBT) is no longer a relevant test for CRC screening. fecal immunochemical testing (FIT) tests, especially quantitative assays, are clearly a reliable stool-based test. Multitarget DNA (mtsDNA) stool testing may represent a viable option as well, although cost and test characteristics are yet fully defined. FIT and mtsDNA represent the options for stool-based CRC screening. In larger screening centers, quantitative FIT assays represent an attractive option for stool-based testing. Qualitative FIT has applicability in smaller centers. Although a large validation trial showed promising results for mtsDNA, further head-to-head trials with FIT will help define the ultimate role of mtsDNA. Ultimately, however, the best test for CRC screening is the one performed stool-based CRC screening as an initial or alternative option can increase participation in CRC screening.
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Huang JL, Fang Y, Liang M, Li STS, Ng SKC, Hui ZSN, Ching J, Wang HH, Wong MCS. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies. AIMS Public Health 2017; 4:289-300. [PMID: 29546218 PMCID: PMC5690455 DOI: 10.3934/publichealth.2017.3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the proven effectiveness of colorectal cancer (CRC) screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. METHODS A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. DISCUSSION The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. CONCLUSION Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to eliminate disparities and inequity in CRC screening service.
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Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Miaoyin Liang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shannon TS Li
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simpson KC Ng
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zero SN Hui
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Ching
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Martin Chi Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
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Liwen Huang J, Chen P, Yuan X, Wu Y, Haoxiang Wang H, Chisang Wong M. An algorithm to predict advanced proximal colorectal neoplasia in Chinese asymptomatic population. Sci Rep 2017; 7:46493. [PMID: 28418028 PMCID: PMC5394471 DOI: 10.1038/srep46493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/15/2017] [Indexed: 12/22/2022] Open
Abstract
This study aims to develop and validate a new algorithm that incorporates distal colonoscopic findings to predict advanced proximal neoplasia (APN) in a Chinese asymptomatic population. We collected age, gender, and colonoscopic findings from a prospectively performed colonoscopy study between 2013 and 2015 in a large hospital-based endoscopy unit in Shanghai, China. Eligible subjects were allocated to a derivation group (n = 3,889) and validation group (n = 1,944) by random sampling. A new index for APN and its cut-off level were evaluated from the derivation cohort by binary logistic regression. The model performance was tested in the validation cohort using area under the curve (AUC). Age, gender, and distal finding were found to be independent predictors of APN in the derivation cohort (p < 0.001). Subjects were categorized into Average Risk (AR) and High Risk (HR) based on a cut-off score of 2. The AUC of the derivation and validation cohorts were 0.801 (0.754-0.847) and 0.722 (0.649-0.794), respectively. In the validation cohort, those in the HR group had a 3.57 fold higher risk of APN when compared with the AR group (P < 0.001), requiring 18 (95% CI = 12-28) follow-up colonoscopies to detect 1 APN. This new clinical index is useful to stratify APN risk in Chinese population.
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Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chen
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Xiaoqin Yuan
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Yunlin Wu
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Martin Chisang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People’s Republic of China
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People’s Republic of China
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Intracranial volume pressure response in infants and children: preliminary report of a predictive marker in metabolic coma. Crit Care Med 1982; 11:e00113. [PMID: 31899692 PMCID: PMC7056047 DOI: 10.14309/ctg.0000000000000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Intracranial volume-pressure response was assessed in 6 children suffering from metabolic coma and ranging in age 2 months-13 years. No untoward pressure or infectious complications occurred. The relationship between baseline mean intracranial pressure (MICP) and volume-pressure response assessment (VPRA) in these patients seems to be exponential rather than linear. By itself, the test is no better than baseline MICP at identifying patients at greatest risk of developing significantly increased intracranial pressure (ICP). When used in conjunction with baseline MICP, this method of VPRA identifies a population with an 80% risk of developing serious ICP elevations within a 4 h time period. Patients with best overall prognosis had significantly lower mean VPRA values than those with poorest overall prognosis.
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