Association of weekend admission with hospital length of stay, time to chemotherapy, and risk for respiratory failure in pediatric patients with newly diagnosed leukemia at freestanding US children's hospitals.
Association of weekend admission with hospital length of stay, time to chemotherapy, and risk for respiratory failure in pediatric patients with newly diagnosed leukemia at freestanding US children's hospitals.
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美国独立儿童医院新诊断白血病儿科患者周末入院与住院时间、化疗时间和呼吸衰竭风险的关系。
DOI：
10.1001/jamapediatrics.2014.1023
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发表时间：
2014-10
期刊：
影响因子：
26.1
通讯作者：
Aplenc, Richard
中科院分区：
文献类型：
--
作者：
Goodman, Elizabeth K.;Reilly, Anne F.;Fisher, Brian T.;Fitzgerald, Julie;Li, Yimei;Seif, Alix E.;Huang, Yuan-Shung;Bagatell, Rochelle;Aplenc, Richard
在成年白血病患者中，周末入院与住院死亡率增加有关。目前尚不清楚周末诊断入院的儿科白血病患者是否表现出类似的不良后果。评估新诊断白血病儿科患者首次住院时与周末入院相关的不良临床结果。这项回顾性队列研究从1999年到2011年，从儿科健康信息系统数据库中确定了住院指数。参与者是新诊断的急性淋巴性白血病或急性髓性白血病的儿童。周末（星期六及星期日）或平日索引入场。住院死亡率、住院时间、化疗时间和器官系统衰竭指标。共发现急性淋巴细胞白血病10 720例，急性髓细胞白血病1323例；2009例患者（16.7%）在周末入院。尽管无论入院日期如何，每天接受重症监护病房级别护理的患者总数是恒定的，但这些患者在周末的总入院人数中所占比例较大。在校正分析中，周末入院的患者在首次入院时死亡率没有增加（优势比1.0;95% CI, 0.8-1.6）。在调整了人口统计学、疾病严重程度和医院水平因素后，因白血病首次入院的患者的住院时间（增加1.4天；95% CI, 0.7-2.1）、开始化疗的时间（增加0.36天，95% CI, 0.3-0.5）和呼吸衰竭的风险（优势比，1.5;95% CI, 1.2-1.7）显著增加。虽然在周末入院的新诊断白血病的儿科患者没有更高的死亡率，但他们的住院时间更长，化疗时间更长，呼吸衰竭的风险更高。在就诊时病情严重的患者在周末指数入院中所占比例较高。通过增加人员配置和获得诊断和治疗资源来优化周末资源，可能有助于减少所有周末入院患者的住院时间，也可能确保那些周末入院的高敏锐度患者获得全面护理。
In adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes. To estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia. This retrospective cohort study from 1999 to 2011 featured index hospital admissions identified from the Pediatric Health Information System database. Participants were children with newly diagnosed acute lymphoid leukemia or acute myeloid leukemia. Weekend (Saturday and Sunday) or weekday index admission. Inpatient mortality, length of inpatient stay, time to chemotherapy, and organ-system failure in index admission. A total of 10 720 patients with acute lymphoid leukemia and 1323 patients with acute myeloid leukemia were identified; 2009 patients (16.7%) were admitted on the weekend. While the total daily number of patients receiving intensive care unit–level care was constant regardless of the day of admission, these patients represented a larger percentage of total admissions on weekends. In adjusted analyses, patients admitted on the weekend did not have an increased rate of mortality during the first admission (odds ratio, 1.0; 95% CI, 0.8–1.6). Patients whose initial admission for leukemia occurred during a weekend had a significantly increased length of stay (1.4-day increase; 95% CI, 0.7–2.1), time to initiation of chemotherapy (0.36-day increase; 95% CI, 0.3–0.5), and risk for respiratory failure (odds ratio, 1.5; 95% CI, 1.2–1.7) after adjusting for demographics, severity of illness, and hospital-level factors. While pediatric patients with newly diagnosed leukemia admitted on weekends do not have higher mortality rates, they have a prolonged length of stay, increased time to chemotherapy, and higher risk for respiratory failure. Patients who are severely ill at presentation represent a higher proportion of weekend index admissions. Optimizing weekend resources by increasing staffing and access to diagnostic and therapeutic resources may help to reduce hospital length of stay across all weekend admissions and may also ensure the availability of comprehensive care for those weekend admissions with higher acuity.
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DOI：
10.1136/bmj.f7393
发表时间：
2014-01-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Sorita A;Ahmed A;Starr SR;Thompson KM;Reed DA;Prokop L;Shah ND;Murad MH;Ting HH
通讯作者：
Ting HH
影响因子：
3.2
作者：
Lowe, EJ;Pui, CH;Sandlund, JT
通讯作者：
Sandlund, JT
影响因子：
11.4
作者：
Slats, AM;Egeler, RM;Zwaan, CM
通讯作者：
Zwaan, CM
影响因子：
8.3
作者：
McKinney, James S.;Deng, Yingzi;Kostis, John B.
通讯作者：
Kostis, John B.
影响因子：
6.2
作者：
Bejanyan, Nelli;Fu, Alex Z.;Sekeres, Mikkael A.
通讯作者：
Sekeres, Mikkael A.