Disease Severity and Risk Factors of 30-Day Hospital Readmission in Pediatric Hospitalizations for Pneumonia

Abstract

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p < 0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p < 0.01) and higher daily cost (USD 3246 vs. USD 2679, p < 0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

Characteristics of children readmitted with severe pneumonia in Kenyan hospitals

“…Immunosuppressive conditions have also been identified as a risk factor for pneumonia readmission in children (33). Immunosuppression can be due to moderate/severe malnutrition which was significantly associated with readmission in this study.…”

“…Perhaps, older children living longer to have a pneumonia readmission; or no actual particular gender risk for pneumonia rehospitalisation. Prior respiratory syncytial virus lower respiratory tract infection (39), longer index hospitalisations (5, 33), complicated pneumonia (5), and hospital case volume and teaching status (33) were other risk factors for re-hospitalisation for pneumonia identified in the literature but were not measured in this study. These are important variables that need to be examined in future studies.…”

“…Large longitudinal studies of various tertiary referral hospitals in the United States of America (USA), reported a 30-day lower respiratory infection specific re-admission rate and paediatric pneumonia specific re-admission rate of 2.7% (32) and 3.3% (5) respectively, almost four times lower than in our study. A more recent analysis conducted in the USA using the 2018 Nationwide Readmissions Database reported a 30-day severe pneumonia specific re-admission rate among children of 8.7%, while the re-admission rate in children with non-severe pneumonia was 4.7% (33). The lower estimates found in the USA may be attributed to the difference in income contexts, pneumonia definitions, and the fact that these were strictly 30-day outcomes.…”

“…Nationwide Readmissions Database reported a 30-day severe pneumonia specific readmission rate among children of 8.7%, while the re-admission rate in children with nonsevere pneumonia was 4.7% (33). The lower estimates found in the USA may be attributed to the difference in income contexts, pneumonia definitions, and the fact that these were strictly 30-day outcomes.…”

Characteristics of children readmitted with severe pneumonia in Kenyan hospitals

“…Large longitudinal studies of various tertiary referral hospitals in the United States of America (USA), reported a 30-day lower respiratory infection specific re-admission rate and paediatric pneumonia specific re-admission rate of 2.7% [ 32 ] and 3.3% [ 5 ] respectively, almost four times lower than in our study. A more recent analysis conducted in the USA using the 2018 Nationwide Readmissions Database reported a 30-day severe pneumonia specific re-admission rate among children of 8.7%, while the re-admission rate in children with non-severe pneumonia was 4.7% [ 33 ]. A severe pneumonia readmission prevalence of 11% is higher than reports in the literature (2.7–8.7%) and is likely dependent on the context.…”