Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Sunitha V. Kaiser, Leigh Anne Bakel, Megumi J. Okumura, Andrew D. Auerbach, Jennifer Rosenthal, Michael D. Cabana

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI).

METHODS: Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death).

RESULTS: For asthma hospitalizations(n = 85 320), risks for both prolonged LOS and complications were increased with each year of age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.05-1.07; AOR 1.05, 95% CI 1.03-1.07, respectively for each outcome) and in children with chronic conditions (AOR 4.87, 95% CI 4.15-5.70; AOR 21.20, 95% CI 15.20-29.57, respectively). For LRI hospitalizations (n = 204 950), risks for prolonged LOS and complications were decreased with each year of age (AOR 0.98, 95% CI 0.97-0.98; AOR 0.95, 95% CI 0.94-0.96, respectively) and increased in children with chronic conditions (AOR 9.86, 95% CI 9.03-10.76; AOR 56.22, 95% CI 46.60-67.82, respectively). Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95% CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95% CI 1.33-1.97).

CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions).

Original languageEnglish (US)
Pages (from-to)461-473
Number of pages13
JournalHospital pediatrics
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

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Length of Stay
Hospitalization
Odds Ratio
Confidence Intervals
Pediatrics
Asthma
Respiratory Tract Infections
Urban Hospitals
Teaching Hospitals
Noninvasive Ventilation
Quality of Health Care
Child Care
Artificial Respiration
Cross-Sectional Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

Cite this

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations. / Kaiser, Sunitha V.; Bakel, Leigh Anne; Okumura, Megumi J.; Auerbach, Andrew D.; Rosenthal, Jennifer; Cabana, Michael D.

In: Hospital pediatrics, Vol. 5, No. 9, 01.09.2015, p. 461-473.

Research output: Contribution to journalArticle

Kaiser, Sunitha V. ; Bakel, Leigh Anne ; Okumura, Megumi J. ; Auerbach, Andrew D. ; Rosenthal, Jennifer ; Cabana, Michael D. / Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations. In: Hospital pediatrics. 2015 ; Vol. 5, No. 9. pp. 461-473.
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abstract = "BACKGROUND AND OBJECTIVES: Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI).METHODS: Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death).RESULTS: For asthma hospitalizations(n = 85 320), risks for both prolonged LOS and complications were increased with each year of age (adjusted odds ratio [AOR] 1.06, 95{\%} confidence interval [CI] 1.05-1.07; AOR 1.05, 95{\%} CI 1.03-1.07, respectively for each outcome) and in children with chronic conditions (AOR 4.87, 95{\%} CI 4.15-5.70; AOR 21.20, 95{\%} CI 15.20-29.57, respectively). For LRI hospitalizations (n = 204 950), risks for prolonged LOS and complications were decreased with each year of age (AOR 0.98, 95{\%} CI 0.97-0.98; AOR 0.95, 95{\%} CI 0.94-0.96, respectively) and increased in children with chronic conditions (AOR 9.86, 95{\%} CI 9.03-10.76; AOR 56.22, 95{\%} CI 46.60-67.82, respectively). Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95{\%} CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95{\%} CI 1.33-1.97).CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions).",
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AU - Kaiser, Sunitha V.

AU - Bakel, Leigh Anne

AU - Okumura, Megumi J.

AU - Auerbach, Andrew D.

AU - Rosenthal, Jennifer

AU - Cabana, Michael D.

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N2 - BACKGROUND AND OBJECTIVES: Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI).METHODS: Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death).RESULTS: For asthma hospitalizations(n = 85 320), risks for both prolonged LOS and complications were increased with each year of age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.05-1.07; AOR 1.05, 95% CI 1.03-1.07, respectively for each outcome) and in children with chronic conditions (AOR 4.87, 95% CI 4.15-5.70; AOR 21.20, 95% CI 15.20-29.57, respectively). For LRI hospitalizations (n = 204 950), risks for prolonged LOS and complications were decreased with each year of age (AOR 0.98, 95% CI 0.97-0.98; AOR 0.95, 95% CI 0.94-0.96, respectively) and increased in children with chronic conditions (AOR 9.86, 95% CI 9.03-10.76; AOR 56.22, 95% CI 46.60-67.82, respectively). Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95% CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95% CI 1.33-1.97).CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions).

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