Attributable Cost and Length of Stay for Central Line-Associated Bloodstream Infections

Goudie, Anthony; Dynan, Linda; Brady, Patrick; Rettiganti, Mallikarjuna

doi:10.1542/peds.2013-3795

Cited by 185 publications

(145 citation statements)

References 15 publications

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“…20 This method has previously been used in evaluating disease outcomes for other hospital-acquired infections. [21][22][23] VRE infection was the dependent variable, and demographic variables, hospital/ geographic variables, and 389 of the most common comorbid diagnostic and procedure CCS codes, as discussed previously, were the independent variables in the model. Patients with an indication of VRE infection (cases) were matched by high-dimensional propensity score, using a greedy matching algorithm, to patients who did not have VRE (controls), with a 1-to-5 matching ratio.…”

Section: Discussionmentioning

confidence: 99%

“…A g distribution was used to model cost, whereas LOS was modeled using a negative binomial distribution. 22,28 The VRE indicator was used as a fixed effect along with other covariates such as age, gender, race/ethnicity, insurance, year, and propensity score (to account for variability across the matched cohorts). The matching of case and controls was taken into account by introducing a random effect for the matching identifier.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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A B S T R A C T OBJECTIVE:Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS:A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizationsper million in 1997 to 120 in 2012 (P , .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P , .001) and higher hospitalization costs (AD $8233, P 5 .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).CONCLUSIONS: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

View full text Add to dashboard Cite

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“…9 Pediatric VTE, CAUTI, and PU can also be identified from administrative data by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. In this study, we aim to (1) describe the pediatric epidemiology of VTE, CAUTI, and PU; and (2) estimate differences in average LOS and excess costs for pediatric patients experiencing VTE, CAUTI, and PU.…”

mentioning

confidence: 99%

Costs of Venous Thromboembolism, Catheter-Associated Urinary Tract Infection, and Pressure Ulcer

et al. 2015

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OBJECTIVE: To estimate differences in the length of stay (LOS) and costs for comparable pediatric patients with and without venous thromboembolism (VTE), catheter-associated urinary tract infection (CAUTI), and pressure ulcer (PU). METHODS:We identified at-risk children 1 to 17 years old with inpatient discharges in the Nationwide Inpatient Sample. We used a high dimensional propensity score matching method to adjust for case-mix at the patient level then estimated differences in the LOS and costs for comparable pediatric patients with and without VTE, CAUTI, and PU.RESULTS: Incidence rates were 32 (VTE), 130 (CAUTI), and 3 (PU) per 10 000 at-risk patient discharges. Patients with VTE had an increased 8.1 inpatient days (95% confidence interval [CI]: 3.9 to 12.3) and excess average costs of $27 686 (95% CI: $11 137 to $44 235) compared with matched controls. Patients with CAUTI had an increased 2.4 inpatient days (95% CI: 1.2 to 3.6) and excess average costs of $7200 (95% CI: $2224 to $12 176). No statistical differences were found between patients with and without PU. CONCLUSIONS:The significantly extended LOS highlights the substantial morbidity associated with these potentially preventable events. Hospitals seeking to develop programs targeting VTE and CAUTI should consider the improved turnover of beds made available by each event prevented. WHAT'S KNOWN ON THIS SUBJECT:In adults, there is significant increased length of stay, cost, and/or resource use associated with hospitalacquired conditions. Less is known about the epidemiology and impact of many hospitalacquired conditions in pediatric populations. WHAT THIS STUDY ADDS:We find increased pediatric length of stay and costs due to venous thromboembolism and catheter-associated urinary tract infections. This is essential information for hospital administrators and safety departments who are planning interventions to reduce harm associated with these hospital-acquired conditions.

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“…(21)(22)(23) The implications for health services are also significant: it costs almost $70,000 to treat a central line infection in a child. (24,25) Yet the rise of homecare for children with complex medical needs has not been accompanied by a parallel rise in the recognition of these risks, nor in the development of strategies to mitigate them. (26)(27)(28)(29) How best families and children can be supported in in preventing and controlling infection in the community remains poorly understood…”

Section: Increasing Numbers Of Children With Invasive Devices Living mentioning

confidence: 99%

What is the right approach to infection prevention and control for children living at home with invasive devices?

Soto

Tarrant

Dixon‐Woods

2016

Journal of Hospital Infection

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Attributable Cost and Length of Stay for Central Line-Associated Bloodstream Infections

Cited by 185 publications

References 15 publications

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Costs of Venous Thromboembolism, Catheter-Associated Urinary Tract Infection, and Pressure Ulcer

What is the right approach to infection prevention and control for children living at home with invasive devices?

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