The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Brown, Clarice; Shah, Gopi; Mitchell, Ron B.; Lenes-Voit, Felicity; Johnson, Romaine F.

doi:10.1177/0194599820947016

Cited by 18 publications

(26 citation statements)

References 22 publications

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“…56 Black race has also been associated with prolonged length of stay after pediatric tracheostomy placement. 56,57 Similarly, our results identified a higher percentage of nonwhite children from more disadvantaged communities, suggesting that race may affect outcomes. Further, the more disadvantaged group, as expected, more commonly had Medicaid coverage, lower median income, and higher percent of community poverty.…”

Section: Discussionsupporting

confidence: 60%

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

et al. 2021

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Objectives: To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy. Methods: We performed a retrospective case series of children who underwent tracheostomy. Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in-hospital mortality, and 30-day all-cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.Results: A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48-0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.Conclusions: Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.

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Section: Discussionsupporting

confidence: 60%

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

et al. 2021

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“…Standardized cost was consistent with other studies examining national registries. 2,22,23 In general, costs are determined by the LOS and it should be anticipated that complex children requiring tracheostomy have more total cost. Efforts to reduce LOS and barriers to discharge should have the greatest potential to reduce overall cost.…”

Section: Discussionmentioning

confidence: 99%

“…33,34 According to the Kid Inpatient Database, black children are 1.2 times more likely than children of other races to undergo tracheostomy in the US, and this likelihood increases with younger age even after controlling for other factors. 22 The reasons behind this are unclear, and further investigation to determine this worrisome trend is warranted.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

et al. 2021

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Objectives/Hypothesis: To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.Study Design: Retrospective case series.Methods: All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.Results: A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.Conclusions: Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.

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“…We also did not include parents whose primary language was not English. Evidence suggests that racial minority children are more likely than others to receive tracheostomy 35–37 and possibly home ventilation. Exclusion of these valuable perspectives limits the generalizability of our results.…”

Section: Discussionmentioning

confidence: 99%

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Jabre

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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Rationale Deciding about pediatric home ventilation is exceptionally challenging for parents. Understanding the decision‐making needs of parents who made different choices for their children could inform clinician counseling that better supports parents’ diverse values and goals. Objectives To determine how clinicians can meet the decisional needs of parents considering home ventilation using a balanced sample of families who chose for or against intervention. Methods We conducted semi‐structured interviews of parents who chose for or against home ventilation for their child within the previous 5 years. Parents were recruited from three academic centers across the United States. Interviews focused on parent–clinician communication during decision‐making and how clinicians made the process easier or more difficult. Qualitative analysis was used to generate themes and identify key results. Results Thirty‐eight parents were interviewed; 20 chose for and 18 chose against home ventilation. Five themes described their perspectives on how clinicians can facilitate high‐quality decision‐making: demonstrating dedication to families, effectively managing the medical team, introducing the concept of home ventilation with intention, facilitating meaningful conversation about the treatment options, and supporting and respecting the family's decision. Conclusions High‐quality decision‐making around home ventilation depends on individual clinician actions and the complex operations of large academic settings. Strong working relationships with parents, collaborative alliances with colleagues, and appropriate delivery of key content can help meet the needs of parents considering invasive breathing supports for their children.

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The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Cited by 18 publications

References 22 publications

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

Parent perspectives on facilitating decision‐making around pediatric home ventilation

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