{"title":"塞内加尔儿童蛛网膜下腔出血的负担:一项回顾性队列研究","authors":"Mbaye Thioub, Maguette Mbaye, Yvan Zolo, Manal Sghiouar, Sagar Diop, Daouda Wague, El Hadji Cheikh Ndiaye Sy, Alioune Badara Thiam, Tshibambe Nathanael Tshimbombu, Ulrick Sidney Kanmounye, Momar Code Ba","doi":"10.1159/000521450","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal.</p><p><strong>Methods: </strong>Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care.</p><p><strong>Results: </strong>Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08.</p><p><strong>Conclusion: </strong>Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study.\",\"authors\":\"Mbaye Thioub, Maguette Mbaye, Yvan Zolo, Manal Sghiouar, Sagar Diop, Daouda Wague, El Hadji Cheikh Ndiaye Sy, Alioune Badara Thiam, Tshibambe Nathanael Tshimbombu, Ulrick Sidney Kanmounye, Momar Code Ba\",\"doi\":\"10.1159/000521450\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal.</p><p><strong>Methods: </strong>Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care.</p><p><strong>Results: </strong>Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08.</p><p><strong>Conclusion: </strong>Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.</p>\",\"PeriodicalId\":54631,\"journal\":{\"name\":\"Pediatric Neurosurgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000521450\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/12/16 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000521450","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/12/16 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
儿童动脉瘤是罕见的,但潜在的致命的临床条件有不同的病因和结果。在资源匮乏的国家,许多障碍阻碍了儿童动脉瘤性蛛网膜下腔出血(aSAH)的及时诊断和管理。因此,本研究旨在评估由于塞内加尔儿童神经外科护理机会有限而导致的儿童aSAH死亡率。方法:招募2012年至2020年在作者所在机构住院的儿科aSAH患者。采用Spearman Rho相关检验、McNemar检验和Wilcoxon符号秩检验。计算优势比及其95%置信区间,并使用人口归因分数(PAF)量化由于缺乏手术护理导致的aSAH死亡率。结果:24例儿童患者(12名女性和12名男性),年龄12.2岁(95% CI = 10.0-14.3),表现为aSAH。多数患者有单个动脉瘤,直径12.6 (6.1-19.0)mm, 1例有2个。WFNS评分中位数为3(范围[1-4]),平均Fisher评分为4(范围[1-4])。15例(62.5%)患者于住院第15.0天(IQR = 23.0)行手术治疗。总死亡率为20.8%,住院期间缺乏手术治疗死亡的PAF为0.08。结论:在未接受手术治疗的儿科aSAH患者中,8%的死亡可归因于缺乏手术治疗。应实施加强卫生系统的政策,以解决这种卫生不平等现象。
The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study.
Introduction: Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal.
Methods: Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care.
Results: Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08.
Conclusion: Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.
期刊介绍:
Articles in ''Pediatric Neurosurgery'' strives to publish new information and observations in pediatric neurosurgery and the allied fields of neurology, neuroradiology and neuropathology as they relate to the etiology of neurologic diseases and the operative care of affected patients. In addition to experimental and clinical studies, the journal presents critical reviews which provide the reader with an update on selected topics as well as case histories and reports on advances in methodology and technique. This thought-provoking focus encourages dissemination of information from neurosurgeons and neuroscientists around the world that will be of interest to clinicians and researchers concerned with pediatric, congenital, and developmental diseases of the nervous system.