{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:46:36Z","timestamp":1789670796514,"version":"4.0.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Understanding the impact of the social determinants of health on the utilization of healthcare resources is an important step in eliminating inequalities. The goal of this study was to determine the role of social determinants of health in referral patterns, timing of consultation\/intervention, and quality of life in children with Chiari malformation type I (CM-I).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective study was conducted of children aged 0 to 18 years who underwent surgical treatment for CM-I at a single pediatric facility from 2015 to 2019. The variables included demographic and socioeconomic characteristics, referral patterns, timing, and quality of life data based on the Chiari Health Index for Pediatrics (CHIP).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The cohort consisted of 103 surgically treated CM-I patients. No differences were seen in race, sex, insurance, or household income when evaluating referral source (community, specialist, or emergency department) or when comparing patients with incidental versus symptomatic findings. In the evaluation of timing from initial evaluation to surgery, no statistical differences were seen between racial, sex, insurance status, or income groups. Children from households of lower median family income were significantly more likely to report pain at the time of consultation (pain group median [interquartile range] $46,660 [$41,004\u2013$50,367] vs nonpain group $53,604 [$41,427\u2013$59,828], p = 0.004). Those in the lower-income group also reported lower CHIP scores corresponding to increased symptomatology in the nonpain physical symptoms (p = 0.004) and psychosocial domains (p = 0.018).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>There was no evidence of a difference in referral patterns or a delay in time from clinic presentation to surgery based on the traditional social determinants of health categories. Children from households in the lower-income group were associated with increased severity of pain and nonpain symptoms.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.7.peds22114","type":"journal-article","created":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T06:26:54Z","timestamp":1694845614000},"page":"686-691","source":"Crossref","is-referenced-by-count":2,"title":["The role of traditional social determinants of health in referral patterns, timing of surgery, and Chiari Health Index for Pediatrics\u2013determined quality of life in children with symptomatic Chiari type I malformation"],"prefix":"10.3171","volume":"32","author":[{"given":"Katherine A.","family":"Kelly","sequence":"first","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"},{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley S.","family":"Guidry","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunther W.","family":"Wong","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison C.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Girgis","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chevis N.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Cools","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg Sci","first-page":"215","article-title":"Chiari malformations: diagnosis, treatments and failures","volume":"58","author":"Abd-El-Barr MM","year":"2014","unstructured":"Abd-El-Barr MM, Strong CI, Groff MW. Chiari malformations: diagnosis, treatments and failures. J Neurosurg Sci. 2014;58(4):215\u2013221."},{"issue":"6","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"554","article-title":"Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome","volume":"5","author":"Albert GW","year":"2010","unstructured":"Albert GW, Menezes AH, Hansen DR, Greenlee JD, Weinstein SL. Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. J Neurosurg Pediatr. 2010;5(6):554\u2013561."},{"issue":"6","key":"b3","series-title":"J Neurosurg Spine","first-page":"601","article-title":"Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and Chiari malformation Type I in patients with hereditary disorders of connective tissue","volume":"7","author":"Milhorat TH","year":"2007","unstructured":"Milhorat TH, Bolognese PA, Nishikawa M, McDonnell NB, Francomano CA. Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and Chiari malformation Type I in patients with hereditary disorders of connective tissue. J Neurosurg Spine. 2007;7(6):601\u2013609."},{"issue":"5","key":"b4","series-title":"J Neurosurg","first-page":"823","article-title":"Chiari\u2019s description of cerebellar ectopy (1891). With a summary of Cleland\u2019s and Arnold\u2019s contributions and some early observations on neural-tube defects","volume":"75","author":"Koehler PJ","year":"1991","unstructured":"Koehler PJ. Chiari\u2019s description of cerebellar ectopy (1891). With a summary of Cleland\u2019s and Arnold\u2019s contributions and some early observations on neural-tube defects. J Neurosurg. 1991;75(5):823\u2013826."},{"key":"b5","series-title":"World Neurosurg","first-page":"7","article-title":"A systematic review of Chiari I malformation: techniques and outcomes","volume":"88","author":"Zhao JL","year":"2016","unstructured":"Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg. 2016;88:7\u201314."},{"issue":"1","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study","volume":"25","author":"Koueik J","year":"2020","unstructured":"Koueik J, Sandoval-Garcia C, Kestle JRW,  Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr. 2020;25(1):21\u201329."},{"issue":"8","key":"b7","series-title":"WMJ","first-page":"35","article-title":"Chiari type I malformation: overview of diagnosis and treatment","volume":"101","author":"Nash J","year":"2002","unstructured":"Nash J, Cheng JS, Meyer GA, Remler BF. Chiari type I malformation: overview of diagnosis and treatment. WMJ. 2002;101(8):35\u201340."},{"issue":"6","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"560","article-title":"Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures","volume":"15","author":"Attenello FJ","year":"2015","unstructured":"Attenello FJ, Ng A, Wen T,  Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures. J Neurosurg Pediatr. 2015;15(6):560\u2013566."},{"issue":"3","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"335","article-title":"Socioeconomic health disparities in pediatric traumatic brain injury on a national level","volume":"29","author":"Kelly KA","year":"2021","unstructured":"Kelly KA, Patel PD, Salwi S, Lovvorn HN III, Naftel R. Socioeconomic health disparities in pediatric traumatic brain injury on a national level. J Neurosurg Pediatr. 2021;29(3):335\u2013341."},{"issue":"3","key":"b10","series-title":"J Neurosurg Pediatr","first-page":"269","article-title":"Racial disparities in health care access among pediatric patients with craniosynostosis","volume":"18","author":"Brown ZD","year":"2016","unstructured":"Brown ZD, Bey AK, Bonfield CM,  Racial disparities in health care access among pediatric patients with craniosynostosis. J Neurosurg Pediatr. 2016;18(3):269\u2013274."},{"key":"b11","series-title":"World Neurosurg","first-page":"431","article-title":"Racial, socioeconomic, and gender disparities in the presentation, treatment, and outcomes of adult Chiari I malformations","volume":"97","author":"Krucoff MO","year":"2017","unstructured":"Krucoff MO, Cook S, Adogwa O,  Racial, socioeconomic, and gender disparities in the presentation, treatment, and outcomes of adult Chiari I malformations. World Neurosurg. 2017;97:431\u2013437."},{"issue":"3","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"305","article-title":"Care for Chiari malformation type I: the role of socioeconomic disadvantage and race","volume":"29","author":"Akbari SHA","year":"2021","unstructured":"Akbari SHA, Oates GR, Gonzalez-Sigler I,  Care for Chiari malformation type I: the role of socioeconomic disadvantage and race. J Neurosurg Pediatr. 2021;29(3):305\u2013311."},{"issue":"4","key":"b13","series-title":"Am J Public Health","first-page":"702","article-title":"Understanding health disparities: the role of race and socioeconomic status in children\u2019s health","volume":"96","author":"Chen E","year":"2006","unstructured":"Chen E, Martin AD, Matthews KA. Understanding health disparities: the role of race and socioeconomic status in children\u2019s health. Am J Public Health. 2006;96(4):702\u2013708."},{"issue":"2","key":"b14","series-title":"Health Econ Policy Law","first-page":"227","article-title":"Socioeconomic status and child health: what is the role of health care, health conditions, injuries and maternal health?","volume":"7","author":"Allin S","year":"2012","unstructured":"Allin S, Stabile M. Socioeconomic status and child health: what is the role of health care, health conditions, injuries and maternal health? Health Econ Policy Law. 2012;7(2):227\u2013242."},{"issue":"4","key":"b15","series-title":"Health Educ Behav","first-page":"331","article-title":"Addressing the social determinants of health of children and youth: a role for SOPHE members","volume":"38","author":"Allensworth DD","year":"2011","unstructured":"Allensworth DD. Addressing the social determinants of health of children and youth: a role for SOPHE members. Health Educ Behav. 2011;38(4):331\u2013338."},{"issue":"2","key":"b16","series-title":"J Neurosurg Pediatr","first-page":"139","article-title":"Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I","volume":"27","author":"Sellyn GE","year":"2020","unstructured":"Sellyn GE, Tang AR, Zhao S,  Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I. J Neurosurg Pediatr. 2020;27(2):139\u2013144."},{"issue":"1","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"76","article-title":"Health-related quality of life in pediatric Chiari Type I malformation: the Chiari Health Index for Pediatrics","volume":"17","author":"Ladner TR","year":"2016","unstructured":"Ladner TR, Westrick AC, Wellons JC III, Shannon CN. Health-related quality of life in pediatric Chiari Type I malformation: the Chiari Health Index for Pediatrics. J Neurosurg Pediatr. 2016;17(1):76\u201385."},{"issue":"26","key":"b18","series-title":"N Engl J Med","first-page":"2456","article-title":"Making neighborhood-disadvantage metrics accessible\u2014the Neighborhood Atlas","volume":"378","author":"Kind AJH","year":"2018","unstructured":"Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible\u2014the Neighborhood Atlas. N Engl J Med. 2018;378(26):2456\u20132458."},{"issue":"7","key":"b19","series-title":"Am J Public Health","first-page":"1137","article-title":"Area deprivation and widening inequalities in US mortality, 1969-1998","volume":"93","author":"Singh GK","year":"2003","unstructured":"Singh GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. 2003;93(7):1137\u20131143."},{"issue":"11","key":"b20","series-title":"Ann Intern Med","first-page":"765","article-title":"Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study","volume":"161","author":"Kind AJ","year":"2014","unstructured":"Kind AJ, Jencks S, Brock J,  Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161(11):765\u2013774."},{"issue":"7","key":"b21","series-title":"Clin J Pain","first-page":"633","article-title":"The co-occurrence of pediatric chronic pain and depression: a narrative review and conceptualization of mutual maintenance","volume":"35","author":"Soltani S","year":"2019","unstructured":"Soltani S, Kopala-Sibley DC, Noel M. The co-occurrence of pediatric chronic pain and depression: a narrative review and conceptualization of mutual maintenance. Clin J Pain. 2019;35(7):633\u2013643."},{"key":"b22","series-title":"Pain Res Manag","first-page":"8328174","article-title":"School anxiety in children and adolescents with chronic pain","volume":"2017","author":"Jastrowski Mano KE","year":"2017","unstructured":"Jastrowski Mano KE. School anxiety in children and adolescents with chronic pain. Pain Res Manag. 2017;2017:8328174."},{"issue":"7","key":"b23","series-title":"Depress Anxiety","first-page":"650","article-title":"Outcomes for treated anxious children: a critical review of long-term-follow-up studies","volume":"26","author":"Nevo GA","year":"2009","unstructured":"Nevo GA, Manassis K. Outcomes for treated anxious children: a critical review of long-term-follow-up studies. Depress Anxiety. 2009;26(7):650\u2013660."},{"issue":"8","key":"b24","series-title":"J Child Psychol Psychiatry","first-page":"924","article-title":"Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood","volume":"51","author":"Saavedra LM","year":"2010","unstructured":"Saavedra LM, Silverman WK, Morgan-Lopez AA, Kurtines WM. Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood. J Child Psychol Psychiatry. 2010;51(8):924\u2013934."},{"issue":"4","key":"b25","series-title":"Psychiatr Clin North Am","first-page":"819","article-title":"Late consequences of chronic pediatric illness","volume":"30","author":"Turkel S","year":"2007","unstructured":"Turkel S, Pao M. Late consequences of chronic pediatric illness. Psychiatr Clin North Am. 2007;30(4):819\u2013835."},{"issue":"6","key":"b26","series-title":"Pediatrics","first-page":"1131","article-title":"Long-term psychosocial sequelae of chronic physical disorders in childhood","volume":"91","author":"Pless IB","year":"1993","unstructured":"Pless IB, Power C, Peckham CS. Long-term psychosocial sequelae of chronic physical disorders in childhood. Pediatrics. 1993;91(6):1131\u20131136."},{"issue":"2","key":"b27","series-title":"Matern Child Health J","first-page":"297","article-title":"Family-centered care: current applications and future directions in pediatric health care","volume":"16","author":"Kuo DZ","year":"2012","unstructured":"Kuo DZ, Houtrow AJ, Arango P, Kuhlthau KA, Simmons JM, Neff JM. Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J. 2012;16(2):297\u2013305."},{"key":"b28","series-title":"Soc Sci Med","first-page":"111","article-title":"Social support, flexible resources, and health care navigation","volume":"190","author":"Gage-Bouchard EA","year":"2017","unstructured":"Gage-Bouchard EA. Social support, flexible resources, and health care navigation. Soc Sci Med. 2017;190:111\u2013118."},{"issue":"5","key":"b29","series-title":"J Community Health","first-page":"976","article-title":"Traveling towards disease: transportation barriers to health care access","volume":"38","author":"Syed ST","year":"2013","unstructured":"Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976\u2013993."},{"issue":"2","key":"b30","series-title":"Acad Pediatr","first-page":"166","article-title":"Medical-financial partnerships: cross-sector collaborations between medical and financial services to improve health","volume":"20","author":"Bell ON","year":"2020","unstructured":"Bell ON, Hole MK, Johnson K, Marcil LE, Solomon BS, Schickedanz A. Medical-financial partnerships: cross-sector collaborations between medical and financial services to improve health. Acad Pediatr. 2020;20(2):166\u2013174."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/32\/6\/article-p686.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/32\/6\/article-p686.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/32\/6\/article-p686.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T12:59:14Z","timestamp":1733489954000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/32\/6\/article-p686.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":30,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2023.7.peds22114","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}