Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Pediatrics. 2013 Jul;132(1):28-36. doi: 10.1542/peds.2012-3877. Epub 2013 Jun 3.
To examine temporal trend in the national incidence of bronchiolitis hospitalizations, use of mechanical ventilation, and hospital charges between 2000 and 2009.
We performed a serial, cross-sectional analysis of a nationally representative sample of children hospitalized with bronchiolitis. The Kids Inpatient Database was used to identify children <2 years of age with bronchiolitis by International Classification of Diseases, Ninth Revision, Clinical Modification code 466.1. Primary outcome measures were incidence of bronchiolitis hospitalizations, mechanical ventilation (noninvasive or invasive) use, and hospital charges. Temporal trends were evaluated accounting for sampling weights.
The 4 separated years (2000, 2003, 2006, and 2009) of national discharge data included 544 828 weighted discharges with bronchiolitis. Between 2000 and 2009, the incidence of bronchiolitis hospitalization decreased from 17.9 to 14.9 per 1000 person-years among all US children aged <2 years (17% decrease; P(trend) < .001). By contrast, there was an increase in children with high-risk medical conditions (5.9%-7.9%; 34% increase; P(trend) < .001) and use of mechanical ventilation (1.9%-2.3%; 21% increase; P(trend) = .008). Nationwide hospital charges increased from $1.34 billion to $1.73 billion (30% increase; P(trend) < .001); this increase was driven by a rise in the geometric mean of hospital charges per case from $6380 to $8530 (34% increase; P(trend) < .001).
Between 2000 and 2009, we found a significant decline in bronchiolitis hospitalizations among US children. By contrast, use of mechanical ventilation and hospital charges for bronchiolitis significantly increased over this same period.
研究 2000 年至 2009 年期间毛细支气管炎住院率、机械通气使用率和住院费用的时间趋势。
我们对全国代表性毛细支气管炎住院儿童样本进行了一系列横断面分析。使用 Kids Inpatient Database 按照国际疾病分类，第九版临床修订版（ICD-9-CM）代码 466.1 识别出年龄＜2 岁的毛细支气管炎患儿。主要结局指标为毛细支气管炎住院率、机械通气（无创或有创）使用率和住院费用。考虑到抽样权重，评估了时间趋势。
4 个独立年份（2000 年、2003 年、2006 年和 2009 年）的全国出院数据包括 544828 例加权毛细支气管炎出院。2000 年至 2009 年，所有＜2 岁美国儿童毛细支气管炎住院率从 17.9 例/1000人年降至 14.9 例/1000人年（下降 17%；P＜0.001）。相比之下，患有高危医疗条件的儿童比例（5.9%～7.9%；增加 34%；P＜0.001）和机械通气使用率（1.9%～2.3%；增加 21%；P=0.008）均有所增加。全国住院费用从 13.4 亿美元增加到 17.3 亿美元（增加 30%；P＜0.001）；这一增长是由于每例病例的平均住院费用从 6380 美元增加到 8530 美元（增加 34%；P＜0.001）所致。
2000 年至 2009 年期间，我们发现美国儿童毛细支气管炎住院率显著下降。相比之下，同期机械通气使用率和毛细支气管炎住院费用显著增加。
