Age- and Diagnosis-Based Trends for Unplanned Pediatric Rehospitalizations in the United States

Amritphale, Nupur; Amritphale, Amod; Vasireddy, Deepa; Batra, Mansi; Sehgal, Mukul; Gremse, David A.

doi:10.7759/cureus.20181

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Similarly, the disorders with high mortality will expectedly have lower readmission rates. While there is a paucity of Indian literature on this aspect, many studies from the developed countries have also reported the age, diagnosis on index admission and presence of chronic conditions as risk factors for readmissions in children 3 , 7 , 30 , 31 , 33 - 37 . Some others have also found gender, length of hospital stay during the index admission, number of past admissions and presence of comorbidities as significant risk factors for readmissions 3 , 32 , 35 , 36 , 38 , 39 .…”

Section: Discussionmentioning

confidence: 99%

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Kundana¹,

Agrawal²,

Tullu³

et al. 2023

Indian Journal of Medical Research

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Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.

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Section: Discussionmentioning

confidence: 99%

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Kundana¹,

Agrawal²,

Tullu³

et al. 2023

Indian Journal of Medical Research

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“…Similarly, in children, mental health disorders were associated with readmissions in many chronic disorders such as migraine, diabetes mellitus, and asthma (15–19). In a large US database study involving approximately 5.5 million pediatric inpatient hospitalization encounters, mood disorders such as anxiety and depression were significantly associated with higher readmissions in children older than 13 years (20). Similarly, in another national-level study using the Pediatric Health Information System (PHIS) database in pediatric migraine, psychiatric comorbidities were significantly associated with increased medication use, higher healthcare utilization, and increased readmissions (17).…”

Section: Introductionmentioning

confidence: 99%

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome

Thavamani

Velayuthan

Patel³

et al. 2023

Am J Gastroenterol

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INTRODUCTION: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS:We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS:We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 (P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders.Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION:Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.

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Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

Pergeline,

Rey,

Fresson

et al. 2023

BMC Health Serv Res

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Background Nationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night. Methods Children were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome. Results Among 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable. Conclusion Higher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.

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Age- and Diagnosis-Based Trends for Unplanned Pediatric Rehospitalizations in the United States

Cited by 3 publications

References 33 publications

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome

Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

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