College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Pediatr Blood Cancer. 2012 May;58(5):741-5. doi: 10.1002/pbc.23262. Epub 2011 Jul 27.
The period of transition from pediatric to adult care is a vulnerable time for patients with sickle cell disease (SCD). The optimal time for transition is unknown and there is no standard of care regarding this timing in the United States.
We collected administrative data from the Pediatric Health Information System for all SCD admissions from 2000 to 2009. We compared reasons for hospitalization and resulting charges in adolescents (13-17 years) and young adults (18-21 years).
We identified 25,371 admissions of adolescents (n = 18,299) and young adults (n = 7,072) with SCD. Median admissions per patient per year was higher in young adults (0.6) compared to adolescents (0.2, P < 0.001), but reasons for hospitalization were similar between the two age groups. Complications of adult SCD such as nephropathy and pulmonary hypertension were rare (<2.5% of discharges) but more frequent in older patients (P = 0.001). Although length of stay was similar between the two groups (median = 4 days), young adults tended to incur higher charges (median +$1,314, P < 0.001) and were less likely to utilize private insurance (P < 0.001). Deaths (0.2% of admissions) were rare and similar across age groups (P = 0.7).
In a national sample of US children's hospitals, adolescents (13-17 years) and young adults (18-21 years) with SCD had similar reasons for hospitalization and low mortality. Further studies are needed to investigate whether extending the age of transition to ≥ 21 years as a national standard may decrease morbidity and mortality, improve health-related quality of life, or increase readiness for transition in patients with SCD.
从儿科过渡到成人护理是镰状细胞病（SCD）患者的脆弱时期。过渡的最佳时间尚不清楚，美国对此时间没有标准的护理措施。
我们从 2000 年至 2009 年期间从儿科健康信息系统中收集了所有 SCD 住院患者的行政数据。我们比较了青少年（13-17 岁）和年轻成年人（18-21 岁）住院的原因和导致的费用。
我们确定了 25371 名患有 SCD 的青少年（n = 18299）和年轻成年人（n = 7072）的住院病例。年轻成年人的每位患者每年的平均住院次数（0.6）高于青少年（0.2，P < 0.001），但两个年龄段的住院原因相似。成人 SCD 的并发症（如肾病和肺动脉高压）很少见（<2.5%的出院患者），但在老年患者中更为常见（P = 0.001）。虽然两组的住院时间相似（中位数为 4 天），但年轻成年人的费用往往更高（中位数+1314 美元，P < 0.001），并且不太可能使用私人保险（P < 0.001）。死亡率（住院人数的 0.2%）较低，且在两个年龄组之间相似（P = 0.7）。
在全国性的美国儿童医院样本中，患有 SCD 的青少年（13-17 岁）和年轻成年人（18-21 岁）的住院原因相似，死亡率低。需要进一步研究是否将过渡年龄延长至≥21 岁作为国家标准，可以降低发病率和死亡率，改善健康相关生活质量，或增加 SCD 患者的过渡准备情况。
