Screening for Pediatric Blunt Cerebrovascular Injury: Review of Literature and a Cost-Effectiveness Analysis
| Autor: | Howard P. Forman, Joseph Schindler, Ajay Malhotra, Xiao Wu, Thomas R. Goodman, Vivek B. Kalra |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness Cost-Benefit Analysis Head Injuries Closed medicine Humans Medical physics Cerebrovascular Trauma Intensive care medicine Child Computed tomography angiography medicine.diagnostic_test Cost–benefit analysis business.industry Decision Trees General Medicine Digital subtraction angiography Cost-effectiveness analysis medicine.disease Cerebral Angiography Data extraction Pediatrics Perinatology and Child Health Economic evaluation Surgery business Tomography X-Ray Computed Monte Carlo Method Pediatric trauma |
| Zdroj: | Journal of pediatric surgery. 50(10) |
| ISSN: | 1531-5037 |
| Popis: | Background Timely and accurate screening for pediatric blunt cerebrovascular injury (BCVI) is important in order to administer appropriate anticoagulation therapy thus preventing stroke. The recommended criteria for screening in children are not clear. We performed a systematic review of the literature for screening and management of BCVI in children and designed a cost-effectiveness analysis in order to determine the optimal strategy for managing pediatric BCVI from a societal perspective. Methods Comprehensive review of studies citing BCVI in pediatric patients was carried out with data extraction and compilation. An economic evaluation of 5 possible screening strategies was performed by designing a decision tree over a 1-year horizon using parameters derived from literature review. Base case calculations were made to compare cost effectiveness for each strategy. Monte Carlo simulation and extensive sensitivity analyses were performed to examine the robustness of the conclusion against key variables. Results Selective anticoagulation therapy in patients with high-risk factors was found to be the most cost-effective strategy and selective computed tomography angiography (CTA) in high-risk patients was the optimal imaging strategy. This conclusion was corroborated by a Monte Carlo simulation of 10,000 iterations. In all sensitivity analyses, selective anticoagulation and selective CTA continue to be the optimal strategy until the risk of anticoagulation complications rises above 3.9%. Conclusions Our study demonstrated selective CTA to be the optimal imaging strategy in order to assess BCVI in children. Further studies are needed for more clearly defined screening criteria. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect