Pediatric Neurosurgery Fellow Lurie Children's Hospital Chicago, Illinois, United States
Introduction: Social determinants of health (SDOH) are implicated in the overall health of children, with social risk factors negatively impacting outcomes. However, this has not been characterized in pediatric shunted hydrocephalus. Thus, we aimed to explore the impact of SDOH on long-term outcomes in pediatric shunted hydrocephalus, examining rates of infection, revision, and mortality with the goal of identifying specific areas of intervention that might improve the outcomes of children undergoing CSF diversion.
Methods: In an all-payer claims administrative database, records between January 2010 and October 2020 were analyzed to identify children undergoing CSF shunting procedures. Children with defined social risk factors were compared to those without to study the implications of these social risk factors on the rates of infection, shunt-related interventions, and mortality within 5-years of their index shunting procedure.
Results: Among the 5,420 children identified as having undergone first-time shunting procedures, 263 (4.9%) were identified to have social risk factors. Children identified to have social risk factors had an increased odds of central nervous system (CNS) infection (Odds Ratio [OR] 2.06, 95% Confidence Interval [CI] 1.45-2.91), revision (OR 2.43, 95% CI 1.89-3.12), and mortality (OR 2.86, 95% CI 1.23-5.72). The mean number of computed tomography (CT) studies (14.60±17.78 vs. 6.34±6.10, p < .001), Magnetic Resonance Imaging (MRI) studies (18.76±24.37 vs. 7.88±24.37, p < .001), and shunt series X-Rays (17.22±19.04 vs. 7.66±8.54, p < .001) were increased among children with social risk factors versus those without.
Conclusion : We found that children with social risk factors defined in our study have increased rates of CNS infection, shunt-related interventions, and mortality within 5-years of CSF shunting. We underscore the importance of characterizing the impact of SDOH in specific conditions, such as pediatric shunted hydrocephalus, as well as look to future directions aimed to mitigate these risk factors with coordination and direction of individualized resources, encouragement of advocacy, and community partnership.
