...Tragic result of our program of childhood vaccination and poor nutrition???

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Something tells me that simply changing the DSM will have little impact on the number of neurologically impaired children presenting for services… http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/30751 Neuro Impairment Among Kids More CommonDownload Complimentary Source PDFBy Kurt Ullman, Contributing Writer, MedPage TodayPublished: January 19, 2012Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse PlannerActivate MedPage Today's CME feature and receive free CME credit on medical stories like this oneAction Points § Note that the term neurological impairment in children referred to children with epilepsy, infants who were born prematurely and have hypoxic-ischemic injury to the brain, as well as children with genetic and metabolic disorders that affected the nervous system.§ Note that this study reviews the significant impact that children with neurological impairment have on the pediatric healthcare system.Children with neurological impairment took up a substantial proportion of inpatient resources at U.S. pediatric hospitals from 1997 to 2006, according to a retrospective study.In 2006, kids with neurological impairment, such as epilepsy and cerebral palsy, accounted for 5.3% of all hospitalizations along with 13.9% (3.4 million) of all bed days and 21.6% ($17.7 billion) of all charges within all hospitals, reported Jay G. Berry, MD, from the Harvard Medical School in Boston, and colleagues, in PLoS Medicine.In that same year, kids with neurological impairment accounted for 24.7% (2.1 million) of bed days and 29% ($12 billion) of hospital charges within children's hospitals.Over the four-year period, the percentage of hospitalizations for neurological impairment in nonchildren's hospitals decreased, from 3% in 1997 to 2.5% in 2006 (P<0.001), while the proportion of patients seen in children's hospitals increased from 11.7% in 1997 to 13.5% in 2006 (P<0.001). " Within children's hospitals, [patients with neurological impairment] accounted for both increasing trends and a substantial proportion of resources over the study period, including nearly one-third of all hospital charges, " the journal editors pointed out in an accompanying summary.They noted that advances in care have led to improved survival of children with neurological impairments and the assumption is that these patients account for an increasing proportion of hospital resources. The authors sought to test this assumption at a national level.They reviewed data on more than 25 million U.S. hospitalizations of children recorded in the Kids' Inpatient Database (1997-2006). Children with neurological impairment (NI) were identified with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). In addition to children with epilepsy, neurological impairment also referred to infants who were born prematurely and had hypoxic-ischemic injury to the brain, as well as children with genetic and metabolic disorders that affected the nervous system.Epilepsy (52.2%) was the most prevalent neurological impairment diagnosis followed by cerebral palsy (15.9%).Within nonchildren's hospitals, there was a decreasing neurological admissions trend that was greater for children with neurological impairment (33.1% decrease) than in those without (25.9% decrease, P<0.001). Among children's hospital facilities, the trend was in the direction of increasing neurological admissions for children with neurological impairment (25.2% increase) and the researchers did not see change in children without neurological impairment (0.0% increase, P< 0.001).When looking at the specialty hospitals for children, neonatal admissions in infants with neurological impairment increased 5% while infants without decreased by 1.5% (P<0.001). Within general hospitals, both groups increased. However, the increase in admissions for infants with NI was more (8.1%) than for those without (3.8% increase, P<0.001).A limitation to this study was that the authors could not determine if the trends they found could have been a function of a changing prevalence of neurological impairment in the general population. Also, the KID database only contains discharge information, so it was not possible to determine if the same size population was just being admitted more often over the years.In order to address the needs of this burgeoning patient population, children's hospitals must develop neurological impairment clinical assessment and care management training for its staff, in addition to forming partnerships between families of children with neurological disorders. " We must ensure that the current healthcare system is staffed, educated, and equipped to serve, with efficiency and quality, this growing segment of vulnerable children, " the authors wrote.This project was supported in part by the Children's Health Research Center at the University of Utah and Primary Children's Medical Center Foundation. Rajendu Srivastava has given talks as Chair of PRIS Network (part of the Network, and his time is funded by the Child Health Corporation of America) and has been asked to speak in his capacity as a hospitalist investigator with receipt of an honorarium (Rady Childrens Hospital; Alberta Children's Hospital (both 2010)). He has also acted as an expert witness on a behalf of a plaintiff for & , Washington D.C., because of his research on children with neurological impairment and their care. All other authors have declared that no competing interests exist. Primary source: PLoS MedicineSource reference:Berry JG, et al " Trends in resource utilization by children with neurological impairment in the united states inpatient health care system: A repeat cross-sectional study " PLoS Med 2012; DOI: 10.1371/journal.pmed.1001158.