K. Williams1, L. M. Baumann1, C. Stake2, R. J. Hendrickson3, F. Abdullah1,2, T. A. Oyetunji1,2 1Northwestern University,Feinberg School Of Medicine,Chicago, IL, USA 2Ann & Robert H Lurie Children’s Hospital Of Chicago,Pediatric Surgery,Chicago, IL, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA
Introduction: Primary spontaneous pneumomediastinum is a rare, often benign, self-limiting condition typically affecting the male adolescent population. Several single-institution retrospective studies have shown that an extensive imaging workup is invariably negative and does not significantly affect clinical decision-making. It has also been shown that these children are often admitted to a critical care setting but are discharged from hospital within three days. Given the current trend toward increasing healthcare expenditure and the need for efficient resource utilization, our aim was to explore current practices in the management of spontaneous pneumomediastinum by analyzing a national database.
Methods: The Pediatric Health Information System (PHIS) database from January 2011 to December 2015 was retrospectively analyzed. All patients aged 10 to 21 years with a principal diagnosis of interstitial emphysema (ICD9 518.1) who were admitted for 3 days or less were included. Patient demographics, imaging studies and associated charges, as well as ICU admission, were extracted. Descriptive analysis was performed using Stata 11.
Results: A total of 368 patients with a principal diagnosis of interstitial emphysema between the ages of 10 and 21 and a hospital LOS less than 3 days were identified. Of these, 77% were male and the mean age at admission was 12.5y(+/-4.8). 15 patients were admitted to the ICU. Among the 368 patients, 863 imaging studies were done. Chest X-ray was the imaging modality used most frequently in all patients; with 21 (5.7%) patients having 3 or more. Over a quarter of the patients (27.1%) had either esophageal or stomach and upper gastrointestinal fluoroscopy. Computed tomography scans were done in approximately 1 in 5 of the patients (18.5%). The associated cost of fluoroscopy in this population was approximately $72,222 while computed tomography added another $140,849.
Conclusion: Besides plain radiography, several other imaging modalities and some ICU care are currently being used in the management of spontaneous pneumomediastinum. This extensive resource utilization is not only expensive, but also associated with unnecessary radiation exposure, particularly for a condition that has been shown to be self-limiting in the vast majority of cases. There is therefore a need for better education and knowledge dissemination.