An analysis of inpatient pediatric sickle cell disease: Incidence, costs, and outcomes
An analysis of inpatient pediatric sickle cell disease: Incidence, costs, and outcomes
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DOI：
10.1002/pbc.26758
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发表时间：
2018-01-01
影响因子：
3.2
通讯作者：
Yanik, Gregory A.
中科院分区：
文献类型：
--
作者：
Bou-Maroun, Laura M.;Meta, Fabien;Yanik, Gregory A.
目的了解小儿镰状细胞病（SCD）的住院特点，并了解住院人口统计和医疗费用。方法从2009年和2012年发布的医疗保健和成本利用项目儿童住院患者数据库中确定患有SCD的任务。疾病特异性继发诊断包括急性胸综合征（ACS）、血管闭塞性疼痛危象（VOC）、脾隔离和卒中/短暂性脑缺血发作，并对患者和医院的人口统计数据进行分析。分析终点包括总医疗支出和死亡率。结果我们回顾了75234例诊断为SCD的住院患者。每年相关的医疗保健支出超过9亿美元。所有入院患者的住院时间（LOS）中位数为3天（四分位数间距[IQR] 2-5天）。VOC是最常见的二次诊断，共有48,698例住院，中位生存期为3天（IQR为2-6天）。在8490例因ACS住院的患者中，婴儿死亡率明显高于其他年龄组（2% vs. 0.3%, P < 0.001）。脑血管事故的住院费用中位数第二高（18,956美元），仅次于ACS（22,631美元）。与非白种人相比，白种人住院期间死于VOC （0.4% vs. 0.1%, P = 0.014）和ACS （4% vs. 0.2%, P < 0.001）的比例较高。结论小儿SCD继发症状住院与医疗费用显著相关。住院期间死亡统计风险增加的患者包括伴有ACS和VOC的SCD并发症的白种人和患者
ObjectiveTo identify characteristics of pediatric sickle cell disease (SCD) hospitalizations and to examine admission demographics and medical expenditures.MethodsAdmissions with SCD were identified from the 2009 and 2012 releases of the Healthcare and Cost Utilization Project's Kids Inpatient Database. Disease-specific secondary diagnoses including acute chest syndrome (ACS), vaso-occlusive pain crisis (VOC), splenic sequestration, and stroke/transient ischemic attack were analyzed for patient and hospital demographics. Analytical endpoints included total healthcare expenditures and mortality.ResultsWe reviewed 75,234 inpatient hospitalizations with a diagnosis of SCD. Over $900,000,000 was spent annually in associated healthcare expenditure. The median length of hospitalization stay (LOS) for all admissions was 3 days (interquartile range [IQR] 2-5 days). VOC was the most frequent secondary diagnosis, recording 48,698 total hospitalizations and a median LOS of 3 days (IQR 2-6 days). Of the 8,490 hospitalizations with ACS, the infant population had a significantly higher mortality rate compared to other age groups (2% vs. 0.3%, P < 0.001). Cerebral vascular accidents incurred the second highest median hospitalization cost ($18,956), behind ACS ($22,631). A high proportion of Caucasian patients died during hospitalization for VOC (0.4% vs. 0.1%, P = 0.014) and ACS (4% vs. 0.2%, P < 0.001) when compared to non-Caucasians.ConclusionInpatient hospitalizations for secondary manifestations of pediatric SCD were associated with significant healthcare expenditures. Patients with an increased statistical risk for death during hospitalization included Caucasians with SCD complications of ACS and VOC, and patients