Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide
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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.
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.
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.
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.
KeywordsBellwether Global Essential surgery Pediatric neurosurgery Surgery Worldwide
American region—Latin America
American region—United States and Canada
Emergency and Essential Surgical Care
Eastern Mediterranean region
endoscopic third ventriculostomy
low- and middle-income countries
lower middle-income countries
magnetic resonance imaging
South-East Asian region
upper middle-income countries
World Health Organization
Western Pacific region
The authors would like to acknowledge Archit Potharazu for his graphical expertise and assistance with the pictorial display of data within this manuscript.
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
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