The Impact of Intracranial Pressure Telesensors: An Observational Propensity-Matched Control Analysis of Service Demand and Costs

BACKGROUND AND OBJECTIVES

Implantable telemetric intracranial pressure (ICP) sensors (telesensors) enable routine, noninvasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with cerebrospinal fluid shunt systems. Here, we aim to explore the impact of these devices on service demand and costs in patients with adult hydrocephalus.

METHODS

We performed an observational propensity-matched control study, comparing patients who had an MScio/Sensor Reservoir (Christoph Miethke, GmbH & Co) against those with a nontelemetric reservoir inserted between March 2016 and March 2018. Patients were matched on demographics, diagnosis, shunt-type, and revision status. Service usage was recorded with frequencies of neurosurgical admissions, outpatient clinics, scans, and further surgical procedures in the 2 years before and after shunt insertion.

RESULTS

In total, 136 patients, 73 telesensors, and 63 controls were included in this study (48 matched pairs). Telesensor use led to a significant decrease in neurosurgical inpatient admissions, radiographic encounters, and procedures including ICP monitoring. After multivariate adjustment, the mean cumulative saving after 2 years was £5236 ($6338) in telesensor patients (£5498 on matched pair analysis). On break-even analysis, cost-savings were likely to be achieved within 8 months of clinical use, postimplantation. Telesensor patients also experienced a significant reduction in imaging-associated radiation (4 mSv) over 2 years.

CONCLUSION

The findings of this exploratory study reveal that telesensor implantation is associated with reduced service demand and provides net financial savings from an institutional perspective. Moreover, telesensor patients required fewer appointments, invasive procedures, and had less radiation exposure, indicating an improvement in both their experience and safety.

Judgement of sleep quality of the previous night changes as the day unfolds: A prospective experience sampling study

How we form judgements of sleep quality is poorly understood. Emerging literature suggests that people infer their sleep quality based on multiple sources of accessible information, raising the possibility that sleep quality judgement may evolve as new relevant information becomes available. This study investigated whether people's rating of sleep quality of the night before changes throughout the following day, and what post-sleep factors are associated with the changes. A prospective experience sampling study of 119 healthy young adults, who completed eight short online surveys interspaced 2 hr apart from 08:00 hours to 22:00 hours. Each survey asked the participants to report total sleep time and sleep quality of the night before, and to provide ratings of current mood, physical and social activity, and pain/discomfort. A memory test was added to the final survey of the day to measure the participants' recall of their first survey responses to sleep quality, as well as total sleep time and mood. The absolute majority (91.1%) of the participants had one or more change in their sleep quality rating across the eight surveys. A similar percentage of change was found for mood rating (100%) but not total sleep time report (20.5%). Memory test in the final survey revealed that the within-person variations in sleep quality rating were not simply memory errors. Instead, positive physical activity post-sleep predicted increases in sleep quality rating. Therefore, judgement of sleep quality of the night before changes as the day unfolds, and post-sleep information can be used by people to infer their sleep quality.