Stefan Bassler

Background: We investigate the management patterns during the study period of pediatric posthemorrhagic hydrocephalus (PHHC) in pediatric (PD) and non-pediatric departments (non-PD). Methods: In this study, data were retrospectively extracted from two large German statutory health insurance funds (~5.2 million clients) between 2010 and 2016. Infants aged ≤12 months were identified using ICD-10-GM codes Q03.-, G91.-, Q04.6, G93.0, Q05.-, and P52.-. The follow-up period was two years. Results: Among 1480 infants with hydrocephalus-related diagnoses, 1043 (71%) had a documented intraventricular hemorrhage. In 395 PHHC cases (36%), treatment was provided by a university/maximum care (UM) hospital. In total, 103 patients (9%) required surgery: performed in PD (n = 84; 82%), non-PD (n = 14; 13%) and unspecified (n = 5; 5%). Primary surgical interventions consisted of external ventricular drainage (38%), cerebrospinal fluid reservoir implantation (39%), ventriculoperitoneal shunt placement (15%), and endoscopic third ventriculostomy (9%). During the first inpatient treatment, complications occurred in 48 patients (47%), with at least one revisional surgery in 98% of cases. After 24 months of follow-up, 77 patients (75%) who required surgical management of PHHC finally received a VPS. No significant differences in complication rates were observed between hospitals with different treating surgical specialties in their departmental structures. UM hospitals treated a higher number of preterms with HC below the 28th gestational week (25% vs. 17%; p < 0.001), and their mortality rate was significantly lower than in non-UM hospitals (4% vs. 7%; p = 0.018). Conclusions: The surgical volume for PHHC in Germany was equally distributed between UM and non-UM hospitals. No statistically significant differences in clinical outcomes were observed between patients treated in hospitals with pediatric versus non-pediatric surgical departmental structures. Non-UM hospitals treated fewer preterm infants below the 28th gestational week and exhibited higher mortality.

Background: Ovarian torsion (OT) is a rare but urgent surgical condition in children and adolescents. Evidence on how management differs between pediatric (PD) and non-pediatric (Non-PD) departments in Germany remains limited. Methods: We conducted a retrospective cohort study using anonymized claims data from two major German statutory health insurance funds (2010–2019), covering 6.3 million insured individuals (≈1 million children). Patients ≤18 years with an inpatient diagnosis of OT (ICD-10-GM N83.5) were analyzed with respect to demographics, department type (PD vs. Non-PD), hospital type (university/maximum care [UM] vs. non-university/maximum care [Non-UM]), surgical procedures, and outcomes. Results: A total of 293 patients (mean age 12.4 ± 4.5 years) were included; 71% were adolescents (12–18 years). Adolescents were predominantly treated in Non-PD (89%), whereas younger children were more often managed in PD (50%; p < 0.0001). Most cases were treated in Non-UM (82%). Laparoscopy was more commonly used in Non-PD departments (85%), while open surgery and oophorectomy occurred more frequently in PD and university hospitals (UM). Ovary-sparing procedures accounted for 77% of all cases, whereas 23% underwent oophorectomy. Mean hospital stay was longer in PD (6.7 ± 9.0 days) than in Non-PD (4.9 ± 2.2 days; p = 0.0167). Readmission rates were comparable across groups. Conclusions: Management of OT in Germany varies markedly by department and hospital type. PD and UM treat more younger patients but perform oophorectomy more frequently, whereas Non-PD and Non-UM favor laparoscopic, ovary-sparing strategies. These differences highlight the urgent need for standardized, evidence-based protocols prioritizing ovarian preservation and optimizing long-term outcomes in affected children and adolescents.

Background: To investigate the management of children and adolescents with isolated and combined chest trauma in pediatric (PD) and non-pediatric departments (non-PD). Methods: Anonymized claims data were provided by two large German statutory health insurance funds, covering 6.3 million clients over a 10-year period (2010–2019). Data were extracted for patients who had an inpatient ICD diagnosis of section S20–S29 (injuries to the thorax) and were ≤18 years of age. Demographic and clinical data were analyzed. Results: A total of 4064 children and adolescents with chest trauma were included (mean age 12.0 ± 5.0 years; 55% male). In 1928 cases (47.4%), treatment was provided at PD. Patients admitted to PD underwent CT imaging less frequently (8.1%; non-PD: 23.1%; p < 0.0001). Children with a chest drain treated at university/maximum care hospitals (UM) showed more injuries involving multiple body regions compared with non-UM (25.8% vs. 4.5%; p = 0.0061) without a difference in the length of hospital stay. Conclusion: Children and adolescents with chest trauma are treated almost equally often in pediatric and adult departments. CT is significantly less frequently used in pediatric departments. Patients with a chest drain treated at a UM showed more concomitant injuries without a longer hospital stay. However, the clinical validity of this finding is questionable.