Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Houston, Texas 77030, USA.
Pediatr Blood Cancer. 2012 Apr;58(4):584-90. doi: 10.1002/pbc.23181. Epub 2011 May 16.
Vaso-occlusive crises (VOCs) contribute to frequent hospitalizations among children with sickle cell disease (SCD). The objective of this study was to identify factors associated with high resource utilization during hospitalizations for VOC.
We analyzed pediatric discharges 0-18 years of age with a primary diagnosis of SCD with crisis from the 2006 Kids' Inpatient Database, a nationally representative sample of pediatric hospital discharges. High resource hospitalizations were defined as those in the highest decile for total charges. We conducted sample-weighted regression analyses to determine associations between independent variables (patient demographics, hospital characteristics, illness severity) and high resource use.
There were 9,893 (0.371%) discharges for children with VOCs. Median total hospitalization charges were $10,691. In multivariate analysis, children 15-18 years of age (odds ratio [OR] 3.39, 95% confidence interval [CI] 2.54-4.53), 10-14 years of age (OR 2.72, 95% CI 2.07-3.59), and 5-9 years of age (OR 1.74, 95% CI 1.30-2.34) had higher odds of high resource hospitalizations compared to children 0-4 years of age. Care in a children's hospital had three times the odds of high resource use compared to care in a general hospital. Discharges with secondary diagnoses including pneumonia (OR 2.46, 95% CI 1.96-3.09) and constipation (OR 1.78, 95% CI 1.31-2.40) were also associated with high resource use.
Older age and secondary diagnoses were associated with high resource use during VOC hospitalizations. These findings suggest the need to improve adherence to comprehensive care among older children to prevent VOCs and standardize protocols to manage VOC complications.
血管阻塞危象（VOC）导致镰状细胞病（SCD）患儿频繁住院。本研究的目的是确定与 VOC 住院期间高资源利用相关的因素。
我们分析了来自 2006 年儿童住院数据库的 0-18 岁患有 SCD 合并危象的儿科出院患者，该数据库是儿科住院患者的全国代表性样本。高资源住院定义为总费用最高十分位数的住院。我们进行了样本加权回归分析，以确定独立变量（患者人口统计学、医院特征、疾病严重程度）与高资源使用之间的关联。
有 9893 例（0.371%）患有 VOC 的儿童出院。中位总住院费用为 10691 美元。在多变量分析中，15-18 岁的儿童（比值比 [OR] 3.39，95%置信区间 [CI] 2.54-4.53）、10-14 岁的儿童（OR 2.72，95% CI 2.07-3.59）和 5-9 岁的儿童（OR 1.74，95% CI 1.30-2.34）比 0-4 岁的儿童有更高的高资源住院的几率。在儿童医院接受治疗的患者比在综合医院接受治疗的患者高资源使用的几率高 3 倍。继发性诊断包括肺炎（OR 2.46，95% CI 1.96-3.09）和便秘（OR 1.78，95% CI 1.31-2.40）也与高资源使用相关。
年龄较大和继发性诊断与 VOC 住院期间的高资源使用相关。这些发现表明，需要提高年长儿童对综合护理的依从性，以预防 VOC，并规范处理 VOC 并发症的方案。
