Tuesday, January 21st, 2014
Hospitals vary greatly in how they treat children who are undergoing surgery to have their tonsils out, according to a new study published in the journal Pediatrics. More from NBC News:
Getting your tonsils out: It’s a rite of passage for hundreds of thousands of U.S. kids every year.
Yet a study released Monday shows hospitals vary greatly in just how they handle this common procedure. And kids fare differently depending on which hospital they go to. At the best hospitals, just three percent of kids came back for complications like bleeding. But at others, close to 13 percent did.
It is the latest in a series of studies showing that Americans get vastly different care depending on where they live.
It’s not clear why, but the researchers who did the study say it will be worth looking into so that all hospitals can make sure children recover well from the operations. New guidelines issued in 2011 may help get all hospitals and pediatric surgeons on the same page, other experts said.
….Dr. Sanjay Mahant of the University of Toronto and the Hospital for Sick Children in Toronto, and colleagues across the United States, looked at the records of nearly 140,000 children who got simple, uncomplicated tonsillectomies at 36 children’s hospitals between 2004 and 2010. All got same-day operations and were sent home on the day of their procedure.
Over that time, about 8 percent had to go back to the hospital within a month, usually for bleeding.
The researchers also looked at the use of two common drug types — dexamethasone, which can reduce complications such as nausea, and antibiotics.
New guidelines issued in 2011 advise giving dexamethasone to children before the operation, and they recommend against giving any antibiotics.
In the study before the guidelines came out, 76 percent of the children got dexamethasone, and at some hospitals almost none did. And 16 percent of children got antibiotics, although at some hospitals 90 percent of patients did.
“More than 500,000 tonsillectomies are performed each year in children in the United States, most commonly for sleep-disordered breathing and recurrent throat infections,” the researchers wrote. There shouldn’t be such variation from one hospital to another, they said.
Image: Child recovering in bed, via Shutterstock
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Thursday, December 12th, 2013
A new study from Dartmouth University researchers has found that kids who grow up in different cities and towns are more or less likely to receive different types of health care such as tonsil removals or CT scans. The research paints a confusing picture of standards of care for young patients, as Reuters reports:
Children in Lebanon, New Hampshire, are more than twice as likely to have their tonsils removed as those in Bangor, Maine. Kids in Lewiston, Maine, are 50 percent more likely to have a CT scan of their head than are kids in Portland, Maine, or Lebanon and Burlington, Vermont.
Lebanon’s children don’t have especially infection-prone tonsils, and Lewiston’s don’t fall on their heads more than kids elsewhere do. Instead, according to a report released on Wednesday, the glaring variation means that in some cases “children are not receiving enough good care,” said pediatrician and health policy analyst Dr David Goodman of the Geisel School of Medicine at Dartmouth University, who led the study for the Dartmouth Atlas Project. But in other cases they “may be receiving unnecessary care that is harmful.”
Similar research from the project has shown that the rate of medical procedures performed on older Americans covered by Medicare varies enormously depending on where they live.
The new report, which focused on northern New England, is the first to show that geographic variability exists in children’s healthcare, too, raising questions about why tens of thousands of kids are not receiving recommended care such as screening for lead poisoning and why tens of thousands of others are subjected to potentially unneeded treatments such as CTs for stomachaches.
The Dartmouth Atlas was able to examine geographic variations in the medical care provided to children in Maine, New Hampshire and Vermont from 2007 to 2010 because those states are among the few that collect data on all health insurance claims, which the researchers analyzed.
“This suggests that there is a significant amount of overuse of medical services in some areas,” said Dr Vikas Saini, a cardiologist and president of the Lown Institute, a healthcare think tank in Boston. “Especially because unneeded care can expose children to harmful side effects, this is very troubling.”
Image: Child having throat exam, via Shutterstock
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