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Hospital readmissions common among children with pneumonia
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Hospital readmissions are common among young children with pneumonia, especially those with chronic medical conditions, according to study findings in Pediatrics.
Mark I. Neuman, MD, MPH, of Boston Children’s Hospital, and colleagues assessed data from the Pediatric Health Information System, which accounts for an estimated 15% of all pediatric hospitalizations in the United States. Children hospitalized for pneumonia from 2008 to 2011 were included in the study. The study cohort consisted of 82,566 children with a median age of 3 years.
Overall, 7.7% (95% CI, 7.5-7.9) of patients were readmitted for all causes within 30 days of their primary pneumonia hospitalization discharge, and 3.1% (95% CI, 2.9-3.2) were readmitted for a pneumonia-specific cause. For all-cause readmissions, 16.7% occurred within 3 days after discharge; 34% occurred within 1 week; and 58.5% occurred within 2 weeks after discharge.
Hospitals in the Northeast and Midwest had a higher 30-day all-cause readmission rate than other hospitals. Hospitals in the upper quartile of pneumonia hospitalizations were 22% less likely to experience 30-day readmission for any cause compared with hospitals in the lower quartile.
Children younger than 1 year were more likely to be readmitted and experienced almost twice the odds of readmission (OR=1.96; 95% CI, 1.33-2.87) compared with children aged 1 to 4 years. Children with asthma were less likely to be readmitted within 30 days after discharge than children without asthma. Children with a technology dependence were more likely to experience a pneumonia-specific readmission than those without such dependence.
Increased number of previous hospitalizations and increased length of stay were associated with readmission after hospitalization for pneumonia.
Children with complicated pneumonia who did not have a pleural drainage procedure were more likely to experience readmission vs. children with uncomplicated pneumonia. This association was not present among children who underwent a drainage procedure.
Children with chronic condition indicators were more likely to experience an all-cause (OR=3.01; 95% CI, 2.82-3.21) and pneumonia-specific (OR=1.84; 95% CI, 1.69-2.01) readmission compared with children without chronic condition indicators. Children with chronic condition indicators involving the nervous system, digestive system or circulatory system were 17%, 18%, and 19% more likely to experience all-cause readmission than those without chronic condition indicators, respectively. Children with chronic condition indicators involving the respiratory system did not have increased odds of either all-cause or pneumonia-specific readmission. An estimated 20.4% of children with conditions influencing health status experienced readmission within 30 days of discharge.
Overall, the cost for all pneumonia hospitalizations was an estimated $1 billion; readmissions accounted for $163 million (16%) of total costs, despite accounting for 7.7% of total pneumonia hospitalizations.
“Approximately 8% of children experience a readmission within 30 days of pneumonia hospitalization, and children <1 year of age and those with chronic medical conditions are at higher risk of readmission. The costs associated with pneumonia readmissions are substantial. Our findings may help to target interventions and provide anticipatory guidance for clinicians and for patients at greatest risk of hospital readmission,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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