Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood

Shah, Samir S.; Hall, Matthew; Newland, Jason G.; Brogan, Thomas V.; Farris, Reid; Williams, Derek J.; Larsen, Gitte; Fine, Bryan R.; Levin, Jeffrey S.; Wagener, Jeffrey S.; Conway, Patrick H.; Myers, Angela

doi:10.1002/jhm.872

Cited by 37 publications

(24 citation statements)

References 41 publications

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“…The adjusted costs of patient visits were calculated. In order to calculate adjusted costs, the actual charges recorded in PHIS were adjusted by the United States’ Centers for Medicare and Medicaid price/wage index for each hospital location and hospital-level cost-to-charge ratios 14 15…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and acute management of patients with concussion at children's hospitals

et al. 2013

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ObjectivesTo describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients.DesignCross-sectional study.SettingChildren's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period.PatientsAll emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion.Main outcome measuresThe proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion.ResultsThe number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472–$1009, vs US$191, IQR US$114–$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292–$3770).ConclusionsAlthough the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.

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Section: Methodsmentioning

confidence: 99%

Diagnosis and acute management of patients with concussion at children's hospitals

et al. 2013

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“…Hospitalizations for parapneumonic empyema were identified as any pneumonia hospitalization with a diagnosis of empyema (primary or otherwise). A separate analysis was conducted to assess a more specific outcome measure using only hospitalizations for parapneumonic empyema with a documented thoracentesis-related procedure for the diagnosis or management of empyema, including video-assisted thorascopic surgery (ICD9-CM: 34.04, 34.06, 34.09, 34.21, 34.51, 34.52, and 34.91) [23]. In addition, discharge diagnosis codes were used to classify hospitalizations for parapneumonic empyema based on the likely causative organism into mutually exclusive groups and according to the following hierarchy: pneumococcal (ICD9-CM: 481), streptococcal (ICD9-CM: 482.3, 041.0, 038.0), staphylococcal (ICD9-CM: 482.4, 041.1, 038.1) or unspecified (other/unknown etiology).…”

Section: Hospitalizations For Parapneumonic Empyemamentioning

confidence: 99%

“…In addition, discharge diagnosis codes were used to classify hospitalizations for parapneumonic empyema based on the likely causative organism into mutually exclusive groups and according to the following hierarchy: pneumococcal (ICD9-CM: 481), streptococcal (ICD9-CM: 482.3, 041.0, 038.0), staphylococcal (ICD9-CM: 482.4, 041.1, 038.1) or unspecified (other/unknown etiology). The ICD9-CM codes to identify hospitalizations for pneumonia have been validated in prior studies, and the strategy to identify hospitalizations for parapneumonic empyema, including by likely causative organism, have been reported previously [7,8,[23][24][25].…”

Section: Hospitalizations For Parapneumonic Empyemamentioning

confidence: 99%

Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era

Wiese

Griffin

Zhu

et al. 2016

Vaccine

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Background-Parapneumonic empyema, a serious complication of pneumonia, started increasing among U.S. children before the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, and continued afterwards. This increase was due in part to pneumococcal serotypes not included in PCV7 that were included in the new 13-valent (PCV13) vaccine introduced in 2010. We assessed changes in the incidence of empyema hospitalizations among U.S. children after PCV13 introduction.

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“…Adjusted billed charges are the billed charges adjusted by the US Centers of Medicare and Medicaid Services' price/ wage index for the study site's location. 32,33 To compare albuterol of different delivery methods, albuterol equivalents were calculated. Based upon prior research demonstrating equal efficacy between albuterol administered by nebulizer and metered-dose inhaler (MDI), 34 every 2.5 mg of albuterol administered by nebulizer was treated as equivalent to 2 sprays of albuterol (90 mg/spray) administered by MDI.…”

Section: Study Setting and Participantsmentioning

confidence: 99%

Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for inhospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS:Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/ clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization.CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful. Pediatric hospitalizations for obesity-related conditions have doubled in the last decade, mirroring the trend of higher levels of childhood obesity in the United States. [1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting. The studies examining this association have found patients with obesity to have a longer hospital length of stay (LOS) and i...

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Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood

Cited by 37 publications

References 41 publications

Diagnosis and acute management of patients with concussion at children's hospitals

Diagnosis and acute management of patients with concussion at children's hospitals

Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era

Childhood obesity and in-hospital asthma resource utilization

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