Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis
Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis
复制标题
DOI：
10.1542/peds.2006-2353
复制
发表时间：
2007-03-01
期刊：
影响因子：
8
通讯作者：
Freed, Gary L.
中科院分区：
文献类型：
--
作者：
Odetola, Folafoluwa O.;Gebremariam, Achamyeleh;Freed, Gary L.
客观的。我们的目标是描述与严重脓毒症危重儿童的住院死亡率、住院时间和费用相关的患者和医院特征。方法。我们的研究包括使用 2003 年儿童住院数据库对 0 至 19 岁因严重败血症住院的儿童进行的回顾性研究。我们对全国住院率进行了估计，然后根据患者和医院的特征，使用多元回归方法比较了住院死亡率、住院时间和总费用。疾病严重程度通过使用所有患者的精细诊断相关组疾病严重程度分类来测量，分为轻微、中度、严重和极端严重程度。结果。 2003年，全国约有21 448例儿童因严重脓毒症住院。院内死亡率为4.2%。 34% 的住院儿童患有合并症。大多数（70%）病情严重的儿童被送往儿童医院。与幸存者相比，病情严重程度较高的患者和非幸存者的住院时间更长（13.5 天与 8.5 天）。城市医院或儿童医院的住院时间也分别比非儿童医院或乡村医院的住院时间更长。较高的费用与较高的疾病严重程度相关，非幸存者的总费用是幸存者的 2.5 倍。此外，在城市或儿童医院住院的费用也较高。在多变量回归分析中，多种合并症、多器官功能障碍和疾病严重程度与较高的死亡率和较长的住院时间相关。与既没有儿童医院也没有教学地位的医院相比，转院住院以及到儿童医院和非儿童教学医院住院的住院费用更高，住院时间更长。结论。严重儿科败血症的死亡率与患者病情严重程度、合并症和多器官功能障碍有关。许多特征与资源消耗相关，包括医院类型、入院来源和疾病严重程度。
OBJECTIVE. Our goal was to describe patient and hospital characteristics associated with in-hospital mortality, length of stay, and charges for critically ill children with severe sepsis.METHODS. Our study consisted of a retrospective study of children 0 to 19 years of age hospitalized with severe sepsis using the 2003 Kids' Inpatient Database. We generated national estimates of rates of hospitalization and then compared in-hospital mortality, length of stay, and total charges according to patient and hospital characteristics using multivariable regression methods. Severity of illness was measured by using all-patient refined diagnosis-related group severity of illness classification into minor, moderate, major, and extreme severity.RESULTS. There were an estimated 21 448 hospitalizations for severe pediatric sepsis nationally in 2003. The in-hospital mortality rate was 4.2%. Comorbid illness was present in 34% of hospitalized children. Most (70%) of the extremely ill children were admitted to children's hospitals. Length of stay was longer among patients with higher illness severity and nonsurvivors compared with survivors (13.5 vs 8.5 days). Hospitalizations at urban or children's hospitals were also associated with longer length of stay than nonchildren's or rural hospitals, respectively. Higher charges were associated with higher illness severity, and nonsurvivors had 2.5-fold higher total charges than survivors. Also, higher charges were observed among hospitalizations in urban or children's hospitals. In multivariable regression analysis, multiple comorbid illnesses, multiple organ dysfunction, and greater severity of illness were associated with higher odds of mortality and longer length of stay. Higher hospital charges and longer length of stay were observed among transfer hospitalizations and among hospitalizations to children's hospitals and nonchildren's teaching hospitals compared with hospitals, which had neither children's nor teaching status.CONCLUSIONS. Mortality from severe pediatric sepsis is associated with patient illness severity, comorbid illness, and multiple organ dysfunction. Many characteristics are associated with resource consumption, including type of hospital, source of admission, and illness severity.