Readmission Diagnoses After Pediatric Severe Sepsis Hospitalization
Readmission Diagnoses After Pediatric Severe Sepsis Hospitalization
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DOI：
10.1097/ccm.0000000000003646
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发表时间：
2019-04-01
影响因子：
8.8
通讯作者：
Prescott, Hallie C.
中科院分区：
文献类型：
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作者：
Carlton, Erin F.;Kohne, Joseph G.;Prescott, Hallie C.
目的：严重脓毒症是儿科患者医疗保健使用和发病的一个重要原因，但对再入院诊断知之甚少。我们试图确定儿科严重脓毒症后最常见的再入院诊断、脓毒症后再入院的可预防程度，以及再入院诊断的模式与其他常见急性内科住院治疗后的再入院相比是否有所不同。设计：观察性队列研究。设置：国家再入院数据库（2013-2014），包括来自 22 个州的全付费住院治疗。患者：四千五百名28 名儿科严重败血症住院患者，按年龄、性别、合并症和住院时间与 4,528 名因其他常见急性疾病住院的儿科患者进行匹配。干预措施：无。测量和主要结果：我们使用 McNemar 的卡方检验配对数据，比较了 30 天全因、特定诊断和可能可预防的再入院率。在 5,841 名符合条件的严重败血症住院且已出院的儿童中，4,528 名 (77.5%) 与 4,528 名因其他急性医疗状况住院的儿科进行 1:1 匹配。在 4,528 例匹配的脓毒症住院患者中，851 例 (18.8% [95% CI, 16.0-18.2]) 在 30 天内再次住院，相比之下，775 例 (17.1% [95% CI, 17.1-20.0]) 因其他原因住院 (p = 0.02)。最常见的再入院诊断是化疗、装置并发症和败血症，所有这些在败血症后比匹配的非败血症住院后要高出几倍。只有 11.5% 的再入院是因为门诊护理敏感病症，而在常见急性医疗状况后再入院的比例为 23%。结论：超过六分之一的严重败血症儿童在 30 天内再次住院，最常见的是维持化疗、医疗器械并发症或复发性败血症。只有一小部分再入院是由于门诊护理敏感的情况。
Objectives: Severe sepsis is a significant cause of healthcare use and morbidity among pediatric patients, but little is known about readmission diagnoses. We sought to determine the most common readmission diagnoses after pediatric severe sepsis, the extent to which post-sepsis readmissions may be potentially preventable, and whether patterns of readmission diagnoses differ compared with readmissions after other common acute medical hospitalizations.Design: Observational cohort study.Setting: National Readmission Database (2013-2014), including all-payer hospitalizations from 22 states.Patients: Four-thousand five-hundred twenty-eight pediatric severe sepsis hospitalizations, matched by age, gender, comorbidities, and length of stay to 4,528 pediatric hospitalizations for other common acute medical conditions.Interventions: None.Measurements and Main Results: We compared rates of 30-day all cause, diagnosis-specific, and potentially preventable hospital readmissions using McNemar's chi-square tests for paired data. Among 5,841 eligible pediatric severe sepsis hospitalizations with live discharge, 4,528 (77.5%) were matched 1: 1 to 4,528 pediatric hospitalizations for other acute medical conditions. Of 4,528 matched sepsis hospitalizations, 851 (18.8% [95% CI, 16.0-18.2]) were rehospitalized within 30 days, compared with 775 (17.1% [95% CI, 17.1-20.0]) of matched hospitalizations for other causes (p = 0.02). The most common readmission diagnoses were chemotherapy, device complications, and sepsis, all of which were several-fold higher after sepsis versus after matched nonsepsis hospitalization. Only 11.5% of readmissions were for ambulatory care sensitive conditions compared with 23% of rehospitalizations after common acute medical conditions.Conclusions: More than one in six children surviving severe sepsis were rehospitalized within 30 days, most commonly for maintenance chemotherapy, medical device complications, or recurrent sepsis. Only a small proportion of readmissions were for ambulatory care sensitive conditions.