Outcomes and Patterns of Healthcare Utilization After Hospitalization for Pediatric Critical Illness Due to Respiratory Failure*

Abstract

Objectives: To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. Design: Retrospective cohort study. Setting: Quaternary care PICU. Patients: Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014. Measurements and Main Results: Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6–10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0–11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4–15) and 14 days (interquartile range, 8–23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28–1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27–1.71; p < 0.0001) within 2 years. Conclusions: After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.

Post‐discharge respiratory outcomes of children with acute respiratory distress syndrome

“…A recent single-center retrospective study documented that over 50% of children with critical illness due to respiratory failure were rehospitalized within 2 years of discharge, 70% of whom were readmitted to the ICU. 27 This study corroborates our findings which highlight the important morbidity faced by PARDS survivor and the pertinence of a PARDS follow-up clinic in the early detection and management of these morbidities.…”

Posthospitalization follow‐up recommendations after pediatric critical illness due to respiratory failure

“…The majority of children experiencing a pediatric critical illness require follow-up care after discharge. 1,2 Children after a critical illness can develop posttraumatic stress disorder (PTSD), behavioral issues, cognitive changes, new morbidities, and new home healthcare needs. 1,[3][4][5][6][7][8][9] Follow-up care often includes a combination of primary care and specialty care provider visits to address these physical and emotional needs after discharge.…”

“…1,2 Children after a critical illness can develop posttraumatic stress disorder (PTSD), behavioral issues, cognitive changes, new morbidities, and new home healthcare needs. 1,[3][4][5][6][7][8][9] Follow-up care often includes a combination of primary care and specialty care provider visits to address these physical and emotional needs after discharge. Prior data have shown that more children are recommended to see a specialist after discharge rather than a primary care provider, with the leading specialists that patients are referred to being pulmonologists, physical and occupational therapists, otolaryngologists, and cardiologists.…”

“…Prior data have shown that more children are recommended to see a specialist after discharge rather than a primary care provider, with the leading specialists that patients are referred to being pulmonologists, physical and occupational therapists, otolaryngologists, and cardiologists. 1,2 Importantly, follow-up care after a pediatric intensive care unit (PICU) stay is not guided by specific professional guidelines and few guidelines exist for posthospital follow-up in pediatrics as a whole. 10,11 Though studies have begun to elucidate follow-up patterns after critical illness, greater characterization of follow-up recommendations is needed.…”

Association of SNP–SNP Interactions of Surfactant Protein Genes with Pediatric Acute Respiratory Failure

“…Without prompt intervention, ARF is associated with significant morbidity and mortality [2]. Single center cohort studies have shown that many children among the ARF survivors develop pulmonary dysfunction at discharge (PDAD) [5,6]. Respiratory infections and direct lung injury are the most common causes of ARF in children [4].…”