Cost Effectiveness of Pediatric Blunt Cerebrovascular Injury Screening: A Decision Tree Analysis

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-25 DOI:10.1016/j.jpedsurg.2025.162296

Alexandra L. Campbell , Dennis Xuan , Prashanth Balaraman , Danielle Tatum , Brian Yorkgitis , David Yu , Patrick McGrew , Jeanette Zhang , Kevin Harrell , Juan Duchesne , Lizheng Shi , Sharven Taghavi

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引用次数: 0

Abstract

Background

Early identification of blunt cerebrovascular injury in the pediatric (<18 years) population (pBVCI) is essential to minimize stroke. However, the most cost-effective screening strategy for pBCVI is unknown, and there is high variability in practice nationwide. We sought to identify the most cost-effective screening strategy for identifying pBCVI and hypothesized that Memphis criteria (MC) would be the most cost-effective due to its high sensitivity.

Study design

A Decision Tree analysis model was used to compare the following BCVI screening strategies in peds: (1) no screening (NS); (2) Denver criteria (DC); (3) Expanded Denver criteria (eDC); (4) MC; (5) McGovern criteria (MG); (6) Utah criteria (UC); and (7) universal screening (US). The model considered a range of pBCVI incidences (0.2–2.7 %) and analyzed costs and utilities over a 5-year time horizon. pBCVI cases detected by screening modalities were assumed to be given antithrombotic therapy which mitigates the risk of stroke and mortality.

Results

Our analysis revealed that at low pBCVI incidences, UC was most cost-saving per additional quality-adjusted life year (QALY) compared to NS, while MC yielded the highest savings at high incidences compared to MG. Sensitivity analyses indicated the cost-effectiveness of screening strategies varied significantly with pBCVI incidence.

Conclusions

The cost-effectiveness of pBCVI screening is contingent upon accurate incidence rates, with no one-size-fits-all solution. Pediatric trauma centers should tailor their screening strategies to local pBCVI rates to enhance cost-efficiency and patient outcomes. Further research is needed to better define BCVI incidence rates in children to inform these decisions.

Type of study

Clinical Research Paper.

Level of evidence

查看原文本刊更多论文

小儿钝性脑血管损伤筛查的成本效益：决策树分析

背景：儿童（< 18岁）人群（pBVCI）钝性脑血管损伤的早期识别对于减少卒中至关重要。然而，最具成本效益的pBCVI筛查策略尚不清楚，并且在全国范围内的实践中存在很大差异。我们试图确定最具成本效益的筛查策略来识别pBCVI，并假设孟菲斯标准（MC）将是最具成本效益的，因为它的高灵敏度。研究设计：采用决策树分析模型比较以下儿科BCVI筛查策略：(1)不筛查（NS）；丹佛标准（DC）；(3)扩展丹佛标准（eDC）；(4) MC;(5) McGovern准则（MG）；(6)犹他州标准；(7)普遍筛选（美国）。该模型考虑了pBCVI发病率范围（0.2-2.7%），并分析了5年时间范围内的成本和效用。通过筛查方式检测到的pBCVI病例被认为给予抗血栓治疗，以减轻中风和死亡的风险。结果：我们的分析显示，在pBCVI发病率低的情况下，与NS相比，UC每额外的质量调整生命年（QALY）节省的成本最多，而与MG相比，MC在高发病率下节省的成本最高。敏感性分析表明，筛查策略的成本-效果随pBCVI发病率的变化而显著不同。结论：pBCVI筛查的成本效益取决于准确的发病率，没有放之四海而皆准的解决方案。儿科创伤中心应根据当地的pBCVI率调整筛查策略，以提高成本效益和患者预后。需要进一步的研究来更好地定义BCVI在儿童中的发病率，从而为这些决策提供信息。研究类型：临床研究论文证据等级：2。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.