Increasing Prevalence of Medically Complex Children in US Hospitals
Increasing Prevalence of Medically Complex Children in US Hospitals
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DOI：
10.1542/peds.2009-1658
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发表时间：
2010-10-01
期刊：
影响因子：
8
通讯作者：
Robbins, James M.
中科院分区：
文献类型：
--
作者：
Burns, Katherine H.;Casey, Patrick H.;Robbins, James M.
目的：在这项研究中，我们使用全国数据来确定 15 年间病情复杂的儿童住院率的变化。 患者和方法：对 1991 年至 2005 年期间 3 年增量的全国住院患者样本（医疗费用和利用项目的组成部分）的数据进行分析，以确定 8 天至 4 岁慢性病儿童住院率的全国趋势。全国住院患者样本的出院诊断分为 9 类复杂慢性病 (CCC)。对 9 个 CCC 类别中每一个类别的住院率进行了单独和组合研究。还检查了因 2 种特定疾病（脑瘫 (CP) 和支气管肺发育不良）住院的儿童的趋势，以及超过 1 个 CCC 类别的额外诊断。 结果：诊断为超过 1 个 CCC 类别的儿童的住院率从每 10 万人 (1991-1993 年) 83.7 人增加到每 10 万人 166 人(2003-2005) (P[r] < .001)。 CP 加上超过 1 个 CCC 诊断的儿童的住院率从每 100 000 人 7.1 增加到 10.4 (P = .002)，而支气管肺发育不良加上超过 1 CCC 诊断的儿童的住院率从每 100 000 9.8 增加到 23.9 (P < .001)。结论：住院率持续增加在诊断为多种 CCC 类别的儿童中，这种情况很常见，而仅患有 CP 的儿童的住院率保持稳定。过去 15 年里，住院儿科患者的相对医疗复杂性有所增加。儿科 2010；126：638646
OBJECTIVE: In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period.PATIENTS AND METHODS: Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined.RESULTS: Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100 000 (1991-1993) to 166 per 100 000 (2003-2005) (P[r] < .001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P = .002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100 000 (P < .001).CONCLUSIONS: Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years. Pediatrics 2010;126:638646