Association of Diagnostic Coding With Trends in Hospitalizations and Mortality of Patients With Pneumonia, 2003-2009

Lindenauer, Peter K.; Lagu, Tara; Shieh, Meng‐Shiou; Pekow, Penelope S.; Rothberg, Michael B.

doi:10.1001/jama.2012.384

Cited by 274 publications

(251 citation statements)

References 26 publications

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“…Recently, changes in coding practices for pneumonia among adults were suggested to account for trends in pneumonia mortality. 27 We did not find changes in trends over time during our study period and included both primary and secondary listed LRTI discharge codes; thus, we captured children with sepsis or respiratory failure as first listed codes, similar to Lindenauer et al 27 Second, age was not included in the Medicaid database. Thus, we likely overestimated the number of children in the ,1-year age group and underestimated the number of children in the 1-to ,2-year age group from the Medicaid data; this would be reflected in rates for these age groups.…”

Section: Resultsmentioning

confidence: 99%

Hospitalizations for Severe Lower Respiratory Tract Infections

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Lower respiratory tract infections (LRTIs), including pneumonia, are in the top 10 causes of death among children in the United States. In high-income countries, 3% to 14% of LRTI hospitalizations have been reported to require admission to an ICU. During 2007During -2011, approximately 31 289 hospitalizations for severe LRTI occurred in children each year in the United States. Children ,1 year of age had the highest rates of severe LRTI and accounted for 30% of severe LRTI hospitalizations. abstract BACKGROUND: Hospitalization for lower respiratory tract infections (LRTIs) among children have been well characterized. We characterized hospitalizations for severe LRTI among children. WHAT THIS STUDY ADDS: METHODS:We analyzed claims data from commercial and Medicaid insurance enrollees (MarketScan) ages 0 to 18 years from 2007 to 2011. LRTI hospitalizations were identified by the first 2 listed International Classification of Diseases, Ninth Revision discharge codes; those with ICU admission and/or receiving mechanical ventilation were defined as severe LRTI. Underlying conditions were determined from out-and inpatient discharge codes in the preceding year. We report insurance specific and combined rates that used both commercial and Medicaid rates and adjusted for age and insurance status. RESULTS:During 2007-2011, we identified 16 797 and 12 053 severe LRTI hospitalizations among commercial and Medicaid enrollees, respectively. The rates of severe LRTI hospitalizations per 100 000 person-years were highest in children aged ,1 year (commercial: 244; Medicaid: 372, respectively), and decreased with age. Among commercial enrollees, $1 condition increased the risk for severe LRTI (1 condition: adjusted relative risk, 2.68; 95% confidence interval, 2.58-2.78; 3 conditions: adjusted relative risk, 4.85; 95% confidence interval, 4.65-5.07) compared with children with no medical conditions. Using commercial/Medicaid combined rates, an estimated 31 289 hospitalizations for severe LRTI occurred each year in children in the United States.CONCLUSIONS: Among children, the burden of hospitalization for severe LRTI is greatest among children aged ,1 year. Children with underlying medical conditions are at greatest risk for severe LRTI hospitalization. Pediatrics 2014;134:546-554 AUTHORS:

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Section: Resultsmentioning

confidence: 99%

Hospitalizations for Severe Lower Respiratory Tract Infections

et al. 2014

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“…Our findings support the recommendation that sepsis is an additional condition that warrants attention at the national level in the United States (34), based on the high frequency with which readmissions occur after sepsis and the associated morbidity and mortality. This consideration would be timely, given temporal trends in diagnostic coding (i.e., increased documentation of sepsis as the principal diagnosis for a hospitalization paired with decreased documentation of pneumonia) (35), due in part to incentives related to public reporting of 30-day risk-standardized mortality for pneumonia (36).…”

Section: Discussionmentioning

confidence: 99%

Post–Acute Care Use and Hospital Readmission after Sepsis

et al. 2015

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Rationale: The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.Objectives: To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods:In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.Measurements and Main Results: Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P , 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P , 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P , 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.Conclusions: Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.

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“…Deaths are highest in the elderly, with mortality rates not improved over the last decade (1). Neutrophils are key effector cells during bacterial infections, with evidence of suboptimal immune responses in the elderly contributing to poor outcomes (2).…”

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confidence: 99%

Pulmonary Infections in the Elderly Lead to Impaired Neutrophil Targeting, Which Is Improved by Simvastatin

Sapey

Patel

Greenwood

et al. 2017

Am J Respir Crit Care Med

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Rationale: Dysregulated neutrophil functions with age and sepsis are described. Statins are associated with improved infection survival in some observational studies, but trials in critically ill patients have not shown benefit. Statins also alter neutrophil responses in vitro.Objectives: To assess neutrophil migratory accuracy with age during respiratory infections and determine if and how a statin intervention could alter these blunted responses.Methods: The migratory accuracy of blood neutrophils from young (aged ,35 yr) and old (aged .60 yr) patients in health and during a lower respiratory tract infection, community-acquired pneumonia, and pneumonia associated with sepsis was assessed with and without simvastatin. In vitro results were confirmed in a double-blind randomized clinical trial in healthy elders. Cell adhesion markers were assessed. Measurements and Main Results:In vitro neutrophil migratory accuracy in the elderly deteriorated as the severity of the infectious pulmonary insult increased, without recovery at 6 weeks. Simvastatin rescued neutrophil migration with age and during mild to moderate infection, at high dose in older adults, but not during more severe sepsis. Confirming in vitro results, high-dose (80-mg) simvastatin improved neutrophil migratory accuracy without impeding other neutrophil functions in a double-blind randomized clinical trial in healthy elders. Simvastatin modified surface adhesion molecule expression and activity, facilitating accurate migration in the elderly.Conclusions: Infections in older adults are associated with prolonged, impaired neutrophil migration, potentially contributing to poor outcomes. Statins improve neutrophil migration in vivo in health and in vitro in milder infective events, but not in severe sepsis, supporting their potential utility as an early intervention during pulmonary infections.Clinical trial registered with www.clinicaltrialsregister.eu (2011-002082-38).

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Association of Diagnostic Coding With Trends in Hospitalizations and Mortality of Patients With Pneumonia, 2003-2009

Cited by 274 publications

References 26 publications

Hospitalizations for Severe Lower Respiratory Tract Infections

Hospitalizations for Severe Lower Respiratory Tract Infections

Post–Acute Care Use and Hospital Readmission after Sepsis

Pulmonary Infections in the Elderly Lead to Impaired Neutrophil Targeting, Which Is Improved by Simvastatin

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