TY - JOUR
T1 - Magnetic Resonance Imaging in Pediatric Myocarditis
T2 - Trends and Associations With Cost and Outcome
AU - O'Halloran, Conor P.
AU - Robinson, Joshua D
AU - Watanabe, Kae
AU - Zumpf, Katelyn B.
AU - Petito, Lucia C.
AU - Marino, Bradley S.
AU - Johnson, Joyce Tawfik
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7
Y1 - 2022/7
N2 - Background: Cardiac magnetic resonance (CMR) provides tissue characterization and structural and functional data. CMR has high sensitivity and specificity for myocarditis in adults and children. The relationship between pediatric CMR use, cost, and clinical outcome has not been studied. Objectives: This work aims to describe temporal trends in CMR imaging for pediatric myocarditis and examine associations between CMR use, hospital cost, and outcomes. Methods: A retrospective cohort study of all inpatients <21 years of age with a diagnosis of myocarditis reported to the Pediatric Health Information System (2004-2019) was performed. Trends in CMR use were examined. A propensity-matched subcohort using center and patient level variables was used to assess whether outcomes differed by CMR use. Results: A total of 4,195 children with myocarditis from 47 hospitals were identified. The median age was 11.5 years (IQR: 1.5-16.0 years) and 2,617 (62%) were male. CMR was used in 23% and mortality occurred in 6%. CMR use during hospitalization increased from 2% in 2004 to 37% in 2019 (odds ratio [OR]: 1.19 [95% CI: 1.17-1.21]). After propensity score matching, CMR use was associated with higher median cost (+$5,340 [95% CI: +$1,739 to +$9,936]) and similar median length of stay (0 days [95% CI: −1 to +1 days]). Using quantile regression, CMR was associated with lower 90th percentile cost (−$77,200 [95% CI: −$127,373 to −$31,339]). More children receiving CMR were discharged alive in the first 30 days after admission (OR: 1.89 days [95% CI: 1.28-2.29]). Within the propensity matched cohort, <10 of 790 CMR recipients died compared to 42 of 790 in the non-CMR group. Conclusions: CMR use in children with myocarditis has increased over the past 15 years. CMR use is associated with higher cost of hospitalization and similar length of stay for most children but lower cost among the sickest children. CMR use in specific patients may improve clinical outcomes at a lower cost.
AB - Background: Cardiac magnetic resonance (CMR) provides tissue characterization and structural and functional data. CMR has high sensitivity and specificity for myocarditis in adults and children. The relationship between pediatric CMR use, cost, and clinical outcome has not been studied. Objectives: This work aims to describe temporal trends in CMR imaging for pediatric myocarditis and examine associations between CMR use, hospital cost, and outcomes. Methods: A retrospective cohort study of all inpatients <21 years of age with a diagnosis of myocarditis reported to the Pediatric Health Information System (2004-2019) was performed. Trends in CMR use were examined. A propensity-matched subcohort using center and patient level variables was used to assess whether outcomes differed by CMR use. Results: A total of 4,195 children with myocarditis from 47 hospitals were identified. The median age was 11.5 years (IQR: 1.5-16.0 years) and 2,617 (62%) were male. CMR was used in 23% and mortality occurred in 6%. CMR use during hospitalization increased from 2% in 2004 to 37% in 2019 (odds ratio [OR]: 1.19 [95% CI: 1.17-1.21]). After propensity score matching, CMR use was associated with higher median cost (+$5,340 [95% CI: +$1,739 to +$9,936]) and similar median length of stay (0 days [95% CI: −1 to +1 days]). Using quantile regression, CMR was associated with lower 90th percentile cost (−$77,200 [95% CI: −$127,373 to −$31,339]). More children receiving CMR were discharged alive in the first 30 days after admission (OR: 1.89 days [95% CI: 1.28-2.29]). Within the propensity matched cohort, <10 of 790 CMR recipients died compared to 42 of 790 in the non-CMR group. Conclusions: CMR use in children with myocarditis has increased over the past 15 years. CMR use is associated with higher cost of hospitalization and similar length of stay for most children but lower cost among the sickest children. CMR use in specific patients may improve clinical outcomes at a lower cost.
KW - children
KW - magnetic resonance imaging
KW - myocarditis
UR - http://www.scopus.com/inward/record.url?scp=85132701396&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132701396&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2022.03.023
DO - 10.1016/j.jcmg.2022.03.023
M3 - Article
C2 - 35798399
AN - SCOPUS:85132701396
SN - 1936-878X
VL - 15
SP - 1230
EP - 1238
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 7
ER -