Cross-sectional comparison of critically ill pediatric patients across hospitals with various levels of pediatric care.
Cross-sectional comparison of critically ill pediatric patients across hospitals with various levels of pediatric care.
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DOI：
10.1186/s13104-015-1550-9
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发表时间：
2015-11-19
影响因子：
1.8
通讯作者：
Carroll AE
中科院分区：
文献类型：
--
作者：
Benneyworth BD;Bennett WE;Carroll AE
住院管理数据来源描述了向住院儿童提供的护理。儿童住院病人数据库（KID）提供具有全国代表性的估计数据，而儿科卫生信息系统（PHIS，一个儿科设施联盟）从收入代码中获得更详细的信息。目的是将基于诊断和程序的危重疾病定义与基于收入的定义结合起来；然后比较不同儿科护理水平的医院。这项回顾性横断面研究利用了公共卫生信息系统数据库中的2009年KID和2009年住院出院病例。<21岁的患者（不包括新生儿）被纳入，重点关注儿科危重疾病。危重疾病定义为：(1)使用诊断和程序代码的重症监护服务（CC服务）和(2)使用收入代码的重症监护病房（ICU）护理。采用卡方和调查加权方法比较人口统计学、侵入性手术和危重疾病类别。比较了公共卫生信息系统医院危重疾病的定义。将综合医院、儿科设施和独立儿童医院（来自KID）确定的CC服务人群与公共卫生信息系统医院的人群进行比较。在公共卫生信息系统医院中，由CC服务确定的重症出院占ICU护理的37.7%。CC服务的出院年龄更小，呼吸系统疾病和侵入性手术的比例更高。公共卫生信息系统医院CC服务鉴定的危重患者与独立儿童医院的危重患者在统计学上相似。儿科设施和综合医院的青少年创伤较多。综合医院的CC服务患者使用侵入性手术的比例较低，创伤、呼吸系统疾病、精神健康问题和一般感染占主导地位。在估计的96,700例CC服务病例中，独立儿童医院出院了22%。在儿科设施（31%）和综合医院（33%）中也有类似比例的危重患者。CC服务的定义捕获了危重儿童中病情更严重的部分。从公共卫生信息系统医院出院的危重病人可能会被推断到独立儿童医院和儿科设施。提供大量儿科重症护理的综合医院则有所不同。利用管理数据的研究可以从多个数据源中受益，这些数据源可以平衡各个数据源的优缺点。本文的在线版本（doi:10.1186/s13104-015-1550-9）包含补充材料，可供授权用户使用。
Inpatient administrative data sources describe the care provided to hospitalized children. The Kids’ Inpatient Database (KID) provides nationally representative estimates, while the Pediatric Health Information System (PHIS, a consortium of pediatric facilities) derives more detailed information from revenue codes. The objective was to contextualize a diagnosis and procedure-based definition of critical illness to a revenue-based definition; then compare it across hospitals with different levels of pediatric care. This retrospective, cross-sectional study utilized the 2009 KID, and 2009 inpatient discharges from the PHIS database. Patients <21 years of age (excluding neonates) were included to focus on pediatric critical illness. Critical illness was defined as: (1) critical care services (CC services) using diagnosis and procedures codes and (2) intensive care unit (ICU) care using revenue codes. Demographics, invasive procedures, and categories of critical illness were compared using Chi square and survey-weighted methods. The definitions of critical illness were compared in PHIS hospitals. CC services populations identified in General Hospitals, Pediatric Facilities, and Freestanding Children’s hospitals (from KID) were compared to those in PHIS hospitals. Among PHIS hospitals, critically ill discharges identified by CC services accounted for 37.7 % of ICU care. CC services discharges were younger and had greater proportion of respiratory illness and invasive procedure use. Critically ill patients identified by CC services in PHIS hospitals were statistically similar to those in Freestanding Children’s hospitals. Pediatric Facilities and General Hospitals had more adolescents with more traumas. CC services patients in general hospitals had lower use of invasive procedures and predominance of trauma, respiratory illness, mental health issues, and general infections. Freestanding children’s hospitals discharged 22 % of the estimated 96,700 CC services cases. Similar proportions of critically ill patients were seen in Pediatric Facilities (31 %) and General Hospitals (33 %). The CC services definition captured a more severely ill fraction of critically ill children. Critically ill discharges from PHIS hospitals can likely be extrapolated to Freestanding Children’s hospitals and Pediatric Facilities. General Hospitals, which provide a significant amount of pediatric critical care, are different. Studies utilizing administrative data can benefit from multiple data sources, which balance the individual strengths and weaknesses. The online version of this article (doi:10.1186/s13104-015-1550-9) contains supplementary material, which is available to authorized users.