title: Scope of practice and outcomes of cerebrovascular procedures in children.
abstract: OBJECTIVE
  The impact of scope of practice of providers (predominantly adult versus predominantly pediatric) on the outcomes of cerebrovascular procedures in children remains an issue of debate. We investigated the association of scope of practice with the outcomes of cerebrovascular interventions.
  
  
  METHODS
  We performed a cohort study of all pediatric patients (younger than 18 years old) who underwent cerebrovascular procedures from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning and mixed effects analysis to account for clustering at the hospital level.
  
  
  RESULTS
  During the study period, there were 1243 pediatric patients who underwent cerebrovascular procedures and met the inclusion criteria. Of these, 631 (50.7 %) underwent treatment by providers with predominantly adult practices and 612 (49.3 %) by physicians who operated predominantly on children. The mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.20; 95 % CI, 0.61-2.38), discharge to a facility (OR, 1.50; 95 % CI, 0.73-3.09), and length of stay (LOS) (adjusted difference, 0.003; 95 % CI, -0.09 to 0.10). These associations persisted in propensity-adjusted models.
  
  
  CONCLUSIONS
  In a cohort of pediatric patients undergoing cerebrovascular procedures from a comprehensive all-payer database, we did not demonstrate a difference in mortality, discharge to a facility, and LOS between providers with predominantly adult and predominantly pediatric practices.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03755, USA. kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: Department of Neurosurgery, Akron General Hospital, Akron, OH, USA.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Coy
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.|Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.|Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.|Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D010372:Pediatrics; D010820:Physicians
keywords: Cerebrovascular intervention; Pediatrics; SPARCS; Scope of practice