Frequent hospitalization burdens children with complex chronic conditions

Complex chronic conditions (CCCs) in children are associated with numerous brief hospitalizations, with a high rate of readmissions, according to a study presented at PAS 2023.

“Children with CCCs are frequently hospitalized and targeted for reduction in hospital resource use,” said the researchers led by Todd W Lyons of the Boston Children’s Hospital in Wayland, Massachusetts, US.  “Little is known about brief length of stay (LOS) admissions in children with CCCs.”

Lyons and colleagues set out to determine the reasons for admission, inpatient health services, and hospital readmissions for one-night LOS in this population. They performed a retrospective analysis of 234,255 admissions of children with a CCC who had a <24-hour admission from 1 January 2016 to 31 December 2021 in 44 children’s hospitals in the Pediatric Health Information System.

The most common diagnoses, procedures, and CCCs were examined. Risk factors for those readmitted within 7 days of their index hospitalization were also assessed through a multivariate analysis. Covariates were as follows: demographics, child opportunity index, intensive care unit (ICU) admission, operation during admission, mechanical ventilation, number of CCCs, and prior ICU admission within the past year.

Among the included children, most were 5 to 12 years of age (n=65,948, 28.2 percent), followed by 1 to 4 (n=59,434, 25.4 percent) and 13 to 17 years old (n=52,852, 22.6 percent). More than half of the patients (52.5 percent) had Medicaid insurance. [TW Lyons, et al, PAS 2023]

Technology dependence was the most common CCC with brief hospitalization, with a total of 61,303 admissions. This was followed by neurologic and neuromuscular conditions (n=54,486) and gastrointestinal conditions (n=51,615).

ICU admission rate was at 8.17 percent, while that for the operating room stood at 2.77 percent. The most common diagnoses for children who were admitted were diabetic ketoacidosis (n=13,178, 5.6 percent), dehydration (n=7,299, 3.1 percent), and sickle cell anaemia crisis (n=4,675, 2.0 percent).

Readmissions

In the cohort, 5.2 percent had readmissions within a week after their brief hospitalization. Among those who were readmitted, 16.6 percent were ICU readmissions. Child opportunity index (COI) showed a marked association with 7-day readmission rates, with having very high COI corresponding to a 1.12-fold greater likelihood of being readmitted compared with very low COI (p<0.001).

Notably, children admitted to the ICU (odds ratio [OR], 0.86, 95 percent confidence interval [CI], 0.08‒0.93) and those who went to the operating room (OR, 0.77, 95 percent CI, 0.68‒0.87) were significantly less likely to be readmitted within 7 days (p<0.001).

On the other hand, children with mechanical ventilation (OR, 1.22, 95 percent CI, 1.10‒1.36) and prior admission to the ICU (OR, 1.48, 95 percent CI, 1.42‒1.55) had significantly higher chances of being readmitted (p<0.001).

“Future investigation is needed to assess the benefits and opportunities to avoid brief hospitalizations for children with CCCs,” said Lyons and colleagues.