Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Houston, Texas 77030, USA.
Pediatr Blood Cancer. 2012 Oct;59(4):679-84. doi: 10.1002/pbc.24065. Epub 2012 Jan 4.
Vaso-occlusive crises (VOC) contribute to frequent hospitalizations among children with sickle cell disease (SCD). The objective of this study was to determine whether length of stay (LOS) has decreased for VOC hospitalizations between 1997 and 2009.
We analyzed pediatric discharges (aged 0-18) with a primary or secondary diagnosis of SCD with crisis from the Kid's Inpatient Database (years 1997, 2003, and 2009), a nationally representative sample of pediatric hospital discharges. We conducted bivariate and multivariate, sample-weighted linear regression analyses to determine associations between independent variables (patient demographics, hospital characteristics, co-diagnoses, and procedures) and LOS.
Both the number (22,661-21,741) and proportion of VOC hospitalizations (0.34-0.29%) among all pediatric hospitalizations marginally decreased between 1997 and 2009 (P < 0.01). Mean LOS decreased from 4.59 to 4.21 days (P < 0.01). For all study years, older age was the only socio-demographic variable associated with longer LOS, controlling for other factors. Between 1997 and 2009, LOS decreased for all age categories, with the largest statistically significant reduction occurring among adolescents (5.69-4.76 days).
Nationally representative hospital data indicate modest but meaningful reductions in LOS for children with VOC over a 12-year period. Adolescents who typically have the greatest disease severity showed the largest reduction in LOS. However, adolescents continue to account for a large proportion of inpatient stays for VOC. These findings illustrate that the adolescent period is a critical time in the lifespan for targeted intervention.
血管阻塞危象（VOC）导致患有镰状细胞病（SCD）的儿童经常住院。本研究的目的是确定 1997 年至 2009 年期间，VOC 住院的住院时间（LOS）是否有所缩短。
我们分析了来自儿科住院数据库（1997 年、2003 年和 2009 年）的以 SCD 伴危象为主要或次要诊断的儿科出院患者（年龄 0-18 岁）的资料，该数据库是儿科住院患者的全国代表性样本。我们进行了双变量和多变量、样本加权线性回归分析，以确定独立变量（患者人口统计学特征、医院特征、合并诊断和程序）与 LOS 之间的关系。
在所有儿科住院患者中，VOC 住院的数量（22661-21741）和比例（0.34-0.29%）都略有下降（P<0.01）。LOS 从 4.59 天降至 4.21 天（P<0.01）。对于所有研究年份，除其他因素外，年龄较大是与 LOS 较长唯一相关的社会人口统计学变量。在 1997 年至 2009 年期间，所有年龄段的 LOS 都有所缩短，其中青少年的降幅最大（5.69-4.76 天）。
全国代表性的医院数据表明，在 12 年的时间内，患有 VOC 的儿童的 LOS 略有但有意义的减少。病情严重程度通常最高的青少年的 LOS 降幅最大。然而，青少年仍然占 VOC 住院的很大比例。这些发现表明，青少年时期是生命中需要针对性干预的关键时期。
