Complications of Serious Pediatric Conditions in the Emergency Department: Definitions, Prevalence, and Resource Utilization
Complications of Serious Pediatric Conditions in the Emergency Department: Definitions, Prevalence, and Resource Utilization
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DOI：
10.1016/j.jpeds.2019.06.064
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发表时间：
2019-11-01
影响因子：
5.1
通讯作者：
Finkelstein, Jonathan A.
中科院分区：
文献类型：
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作者：
Michelson, Kenneth A.;Bachur, Richard G.;Finkelstein, Jonathan A.
目的 使用管理数据来定义和测量急诊科中广泛的急性儿科疾病的并发症，并通过比较有和没有并发症的儿童之间的资源利用率来评估这些定义的有效性。 研究设计 根据当地共识，我们预定义了 16 种急性疾病的并发症，包括阑尾炎、糖尿病酮症酸中毒、卵巢扭转、中风、睾丸扭转和其他 11 种。我们使用来自马里兰州和纽约州医疗保健成本和利用项目全州数据库的 3 年数据对 18 岁以下的患者进行了研究。我们根据病情测量了并发症。对有和没有并发症的患者的资源利用率进行了比较，包括住院时间和费用。结果 我们分析了 27 087 例因病情严重而到急诊室就诊的患者。最常见的是阑尾炎（n = 16 794），24.3%的病例并发1次或以上穿孔（24.1%）、脓肿引流（2.8%）、肠切除（0.3%）或败血症（0.9%）。脓毒症的死亡率最高（5.0%）。患有并发症的儿童具有更高的资源利用率：当存在并发症时，具体情况的住院时间更长，卵巢和睾丸扭转除外。 16 种情况中有 15 种出现并发症的儿童的住院费用较高 (P < .05)，中位数差异为 3108 美元（睾丸扭转）到 137694 美元（中风）。 结论 具有临床意义的并发症是可测量的，并且与资源利用率的增加相关。使用管理数据确定的并发症发生率可用于比较结果并改善儿童的医疗保健服务。
Objectives To define and measure complications across a broad set of acute pediatric conditions in emergency departments using administrative data, and to assess the validity of these definitions by comparing resource utilization between children with and without complications.Study design Using local consensus, we predefined complications for 16 acute conditions including appendicitis, diabetic ketoacidosis, ovarian torsion, stroke, testicular torsion, and 11 others. We studied patients under age 18 years using 3 data years from the Healthcare Cost and Utilization Project Statewide Databases of Maryland and New York. We measured complications by condition. Resource utilization was compared between patients with and without complications, including hospital length of stay, and charges.Results We analyzed 27 087 emergency department visits for a serious condition. The most common was appendicitis (n = 16 794), with 24.3% of cases complicated by 1 or more of perforation (24.1 %), abscess drainage (2.8%), bowel resection (0.3%), or sepsis (0.9%). Sepsis had the highest mortality (5.0%). Children with complications had higher resource utilization: condition-specific length of stay was longer when complications were present, except ovarian and testicular torsion. Hospital charges were higher among children with complications (P < .05) for 15 of 16 conditions, with a difference in medians from $3108 (testicular torsion) to $13 7694 (stroke).Conclusions Clinically meaningful complications were measurable and were associated with increased resource utilization. Complication rates determined using administrative data may be used to compare outcomes and improve healthcare delivery for children.