Impact of psychiatric diagnoses on hospital length of stay in children with sickle cell anemia

Background Reducing the burden of pediatric mental illness requires greater knowledge of Mental Health and Substance Abuse (MHSA) outcomes in children who are at an increased risk of primary psychiatric illness. National data on hospital care for psychiatric illness in children with epilepsy are limited. Methods We used the Kids’ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, from 2003-2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy. Non-parametric and regression analyses determined the association of comorbid epilepsy with specific MHSA diagnoses and examined the impact of epilepsy on length of stay (LOS) for such MHSA diagnoses while controlling for demographic, payer and hospital characteristics. Results We observed 353,319 weighted MHSA hospitalizations of children ages 6 - 20; 3,280 of these involved a child with epilepsy. Depression was the most common MHSA diagnosis in the general population (39.5%) whereas bipolar disorder was the most common MHSA diagnosis among children with epilepsy (36.2%). Multivariate logistic regression models revealed that children with comorbid epilepsy had greater adjusted odds of bipolar disorder (AOR 1.17, 1.04-1.30), psychosis (AOR 1.78, 1.51-2.09), sleep disorder (AOR 5.90, 1.90-18.34), and suicide attempt/ ideation (AOR 3.20, 1.46-6.99) compared to the general MHSA inpatient population. Epilepsy was associated with a greater LOS and a higher adjusted incidence rate ratio (IRR) for prolonged LOS (IRR 1.12, 1.09-1.17), particularly for suicide attempt/ideation (IRR 3.74, 1.68-8.34). Conclusions Children with epilepsy have distinct patterns of hospital care for mental illness and substance abuse, and experience prolonged hospitalization for MHSA conditions. Strategies to reduce psychiatric hospitalizations in this population may require disease specific approaches and should measure disease relevant outcomes. Hospitals caring for large numbers of children with neurological disease (such as academic centers) may have inaccurate measurements of mental health care quality unless the impact of key comorbid conditions such as epilepsy is considered.

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“…children with sickle cell anemia). 10;11 We performed a serial cross-sectional analysis of KID hospitalizations in 2003, 2006, and 2009.…”

Section: Methodsmentioning

confidence: 99%

Hospital care for mental health and substance abuse in children with epilepsy

Thibault

Mendizabal

Abend

et al. 2016

Epilepsy & Behavior

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“…Studies in adult patients with SCD have found associations between mental health symptoms and healthcare utilization (i.e., emergency department utilization, hospital admissions) 5–7. Within the pediatric population, our prior work in SCD found that admissions for SCD pain management were longer when a mental health diagnosis, specifically a mood, anxiety, or substance use disorder, was present upon discharge highlighting the impact of mental health on an individual's ability to cope with pain within the hospital 8. However, mental health disorders also have the potential to impact an individual's ability to manage pain at home resulting in increased admissions for pain.…”

Section: Introductionmentioning

confidence: 97%

Mental health disorders influence admission rates for pain in children with sickle cell disease

Myrvik

Burks

Hoffman

et al. 2012

Pediatric Blood & Cancer

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“…4–10 Among children with complex chronic illnesses, comorbid mood and anxiety disorders are associated with more inpatient utilization; e.g. more admissions, 11,12 longer admissions, 13 and more re-hospitalizations. 14 …”

Section: Introductionmentioning

confidence: 99%

The Influence of Comorbid Mood and Anxiety Disorders on Outcomes of Pediatric Patients Hospitalized for Pneumonia

Doupnik

Mitra²,

Feudtner

et al. 2016

Hospital Pediatrics

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Objective Mood and anxiety disorders are associated with increased inpatient utilization in children with chronic illness. We sought to investigate the association of mood or anxiety disorders and outcomes for hospitalized pediatric patients, using pneumonia as a model. Methods We conducted a retrospective, cross-sectional study of pneumonia hospitalizations in patients 5 to 20 years old, using the nationally representative Healthcare Cost and Utilization Project’s 2012 Kids’ Inpatient Database. We used multivariable logistic and linear regression models stratified by age group to determine the independent association of mood or anxiety disorders with complications and length of stay, adjusted for clinical, demographic, and hospital characteristics. Results Of 34,794 pneumonia hospitalizations, 3.5% involved a patient with a comorbid mood or anxiety disorder. Overall incidence of complications was 13.1%. Mean length of stay was 4.5 days. In adjusted models, comorbid mood or anxiety disorders were associated with increased odds of pneumonia complications in school-aged children (OR 1.80; 95%CI 1.20, 2.71) and adolescents (OR 1.63; 95%CI 1.31, 2.02). Hospitalizations with an associated mood or anxiety disorder were longer than those without, by 11.2% in school-aged children and 13.6% in adolescents (p<0.001). The association of mood and anxiety disorders with longer hospital stay was not modified by the presence of pneumonia complications. Conclusion In pediatric patients hospitalized for pneumonia, a comorbid mood or anxiety disorder is associated with increased odds of complications and longer hospital stay. The presence of pneumonia complications did not influence the relationship between mood or anxiety disorders and length of stay.

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Impact of psychiatric diagnoses on hospital length of stay in children with sickle cell anemia

Abstract: Pediatric patients diagnosed with a psychiatric disorder, specifically mood or anxiety disorders, have longer LOS for VOC. These findings suggest that future interventions aimed at managing VOC may need to consider adjunctive psychiatric assessment and intervention.

Cited by 38 publications

References 20 publications

Hospital care for mental health and substance abuse in children with epilepsy

Hospital care for mental health and substance abuse in children with epilepsy

Mental health disorders influence admission rates for pain in children with sickle cell disease

The Influence of Comorbid Mood and Anxiety Disorders on Outcomes of Pediatric Patients Hospitalized for Pneumonia

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