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Child's Nervous System

, Volume 34, Issue 10, pp 1837–1846 | Cite as

Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide

  • Michael C. DewanEmail author
  • Ronnie E. Baticulon
  • Krishnan Ravindran
  • Christopher M. Bonfield
  • Dan Poenaru
  • William Harkness
A.J. Raimondi ISPN Award

Abstract

Purpose

Quantifying the global burden of pediatric neurosurgical disease—and current efforts addressing it—is challenging, particularly in the absence of uniform terminology. We sought to establish bellwether procedures for pediatric neurosurgery, in order to standardize terminology, establish priorities, and facilitate goal-oriented capacity building.

Methods

Members of international pediatric neurosurgical and pediatric surgical societies were surveyed via the Research Electronic Data Capture (REDCap) platform. Among 15 proposed neurosurgical procedures, respondents assigned numerical grades of surgical necessity and selected hospital-level designation within a three-tiered system. A procedure was considered a bellwether if (a) the majority of respondents deemed it necessary for either a primary- or secondary-level hospital and (b) the procedure was graded at or above the 90th percentile on a continuous scale of essentiality. Data were compiled and analyzed using Stata software.

Results

Complete responses were obtained from 459 surgeons from 76 countries, the majority of whom practiced in a tertiary referral hospital (88%), with a primarily public patient population (64%). Six bellwether procedures were identified for pediatric neurosurgery: shunt for hydrocephalus, myelomeningocele closure, burr holes, trauma craniotomy, external ventricular drain (EVD) insertion, and cerebral abscess evacuation. Few differences in bellwether criteria designations were observed among respondents from different World Health Organization regions and World Bank income groups.

Conclusions

The six bellwether procedures identified can be used as markers of infrastructure capacity at various hospital levels, hence allowing targeted neurosurgical capacity-building in low-resource settings in order to avert disability and death from childhood neurosurgical disease.

Keywords

Bellwether Global Essential surgery Pediatric neurosurgery Surgery Worldwide 

Abbreviations

AFR

African region

AMR-LA

American region—Latin America

AMR-US/C

American region—United States and Canada

CT

computed tomography

EESC

Emergency and Essential Surgical Care

EMR

Eastern Mediterranean region

ETV

endoscopic third ventriculostomy

EUR

European region

HICs

high-income countries

LICs

low-income countries

LIC/MICs

low- and middle-income countries

LMICs

lower middle-income countries

MRI

magnetic resonance imaging

SEAR

South-East Asian region

UMICs

upper middle-income countries

VPS

ventriculoperitoneal shunt

WHO

World Health Organization

WPR

Western Pacific region

Notes

Acknowledgements

The authors would like to acknowledge Archit Potharazu for his graphical expertise and assistance with the pictorial display of data within this manuscript.

Funding

REDcap use and management is funded by Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).

Compliance with ethical standards

Conflicts of interest

None.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Michael C. Dewan
    • 1
    Email author
  • Ronnie E. Baticulon
    • 2
  • Krishnan Ravindran
    • 3
  • Christopher M. Bonfield
    • 1
  • Dan Poenaru
    • 4
  • William Harkness
    • 5
  1. 1.Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of AnatomyUniversity of the Philippines College of MedicineManilaPhilippines
  3. 3.University of MelbourneMelbourneAustralia
  4. 4.Department of Pediatric SurgeryMcGill University Health Centre and Montréal Children’s HospitalMontréalCanada
  5. 5.Great Ormond Street Hospital, Institute of Child HealthUniversity College LondonLondonUK

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