Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy

Abstract

Young, Hispanic children with multiple complex chronic conditions who use Medicaid insurance and are not discharged to post-acute care are at the highest risk for hospital readmission for bRTI post-tracheotomy. Future research should investigate strategies to mitigate this risk for these children.

Encounters From Device Complications Among Children With Medical Complexity

“…19 Similarly, hospital readmissions due to bacterial respiratory tract infections occurred in 36% of children over a median 275 days after tracheostomy placement in a large study. 28 When looking at all reasons for readmission posttracheostomy, 92% were unplanned and 64% were associated with acute respiratory illness. 29 Children with central venous catheters also frequently have clinical triggers directing them to seek ED care (eg, fever).…”

Early Use of Anti-influenza Medications in Hospitalized Children With Tracheostomy

“…We included patients with admission age 30 days to 19 years discharged between October 1, 2007, and September 30, 2015, with (1) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes representing presence of tracheostomy (V44.0, V55.0, 519.00, 519.00, 519.01, 519.02, and 519.09) and (2) influenza infection (487.xx and 488.xx; Fig 1). These ICD-9-CM codes have been previously used to identify hospitalized pediatric patients with the presence of tracheostomy 19,21,25 and laboratoryconfirmed influenza with high specificity and positive predictive value. [26][27][28][29] We excluded patients with any of the following characteristics: (1) age 20 years or older to exclude adult patients; (2) transfer from an outside hospital with inpatient status, given interest in initial treatment of influenza and length of stay (LOS); (3) extreme outliers in LOS defined as median plus 3 times the interquartile range (IQR); (4) death during the index hospitalization because the patients could not have a revisit; (5) presence of surgical procedures unrelated to influenza within first 2 days of hospitalization to minimize the possibility of including patients who acquired or manifested with influenza infection during hospitalizations for other reasons; or (6) missing variables in the database.…”

“…34 Baseline ventilator dependence was defined as having any of the ICD-9-CM codes falling under v46.1x at discharge. 21…”

“…Children with tracheostomy represent a unique population with medical complexity 19 who experience recurrent admissions related to respiratory tract infection. [19][20][21] Despite their elevated risk of viral infections, 22,23 efficacy of antiinfluenza medications remains unknown in this population. We investigated whether early use of anti-influenza medications was associated with improved outcomes in children with tracheostomy hospitalized with influenza.…”

Pediatric Pulmonology year in review 2018: Asthma, physiology/pulmonary function testing, and respiratory infections

“…Bacterial LRI is a common problem in children with tracheostomy. Russell et al reported a large, retrospective study utilizing data from the Pediatric Health Information System database that analyzed risk factors for hospital readmission for bacterial LRI after tracheostomy in children. Not surprisingly, factors independently associated with increased risk for readmission included younger age, complex underlying medical conditions, and markers of lower socioeconomic status.…”