One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Background

Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking.

Methods

Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs.

Results

Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs.

Conclusions

Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

Waterbirths were associated with low pain relief during delivery, high breastfeeding success and healthy newborn infants

AIM

Our aim was to compare the outcomes of waterbirths and conventional births in a Finnish hospital setting for the first time.

METHODS

This retrospective study compared waterbirths with conventional low-risk deliveries from September 2018 to March 2021 at a level-two hospital in Finland. Cases and controls were collected from the patient records database.

RESULTS

The study comprised 78 waterbirths and 1,623 matched conventional births. Mothers in the waterbirth group only required a quarter of the amount of pain medication required by those in the control group. Babies born in water had slightly lower birth temperatures than those born conventionally (36.6°C versus 36.8°C). Umbilical cord artery and vein pH were slightly higher in the waterbirth group than in the control group: artery 7.31 versus 7.28 and vein 7.38 versus 7.35). The Apgar scores did not differ. Hospital stays were shorter in the waterbirth group than in the conventional birth group (1.90 days versus 2.33 days). Babies in the waterbirth group were significantly less likely to require formula than those in the conventional birth group during their hospital stay.

CONCLUSION

Waterbirth decreased the requirement for maternal pain medication and favoured greater breastfeeding and earlier discharge. Prospective studies must confirm these findings.

Antibodies to varicella zoster virus in the cerebrospinal fluid of neonates with seizures

Four neonates with convulsions had IgG antibodies in their cerebrospinal fluid (CSF) to varicella zoster virus (VZV). These antibodies were found in the sera of two of these patients after the age of 6 months. Antibodies to 16 different microbes were studied from the serum and CSF of 201 neonates with neurological problems. The presence of DNA specific to HSV-1, HSV-2, and VZV in the CSF was also investigated using the polymerase chain reaction (PCR). Antibodies to VZV were detected in the CSF of four neonates. Antibody indices suggested production of VZV specific antibodies in the central nervous system. These findings suggest that intrathecal production of antibodies to VZV can appear in neonates with neurological problems, which suggests that intrauterine VZV infection can be acquired without cutaneous symptoms in the mother.