Buicko Jessica L, Parreco Joshua, Willobee Brent A, Wagenaar Amy E, Sola Juan E
Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
J Pediatr Surg. 2017 Oct;52(10):1628-1632. doi: 10.1016/j.jpedsurg.2017.04.010. Epub 2017 Apr 23.
Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients.
The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days.
There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >7days (OR 3.028, p<0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p<0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p<0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%).
Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients.
Level IV - Prognostic and Epidemiological - Retrospective Study.
创伤患者的医院再入院与显著的发病率和增加的医疗费用相关。关于儿科创伤患者早期医院再入院的已发表数据有限。由于目前医疗保健结果和再入院率越来越多地被用作医院质量指标，识别再入院的风险因素至关重要。我们试图确定儿科攻击受害者的全国再入院率，并确定这些患者中最常见的再入院诊断。
查询2013年全国再入院数据库（NRD），以获取所有18岁以下非选择性入院且使用国家创伤数据库标准将E代码设计为攻击的患者。使用18个变量进行多因素逻辑回归，以确定30天内非选择性再入院的比值比（OR）。
有4050名儿科攻击受害者，92名（2.27%）在首次入院期间死亡。在存活患者中，128名（3.23%）在30天内再次入院。在这些再入院患者中，24名（18.75%）转入不同医院，31名（24.22%）因再次攻击而再次入院。与30天内非选择性再入院风险最高相关的变量为：住院时间（LOS）>7天（OR 3.028，p<0.01，95%CI 1.67 - 5.50）、精神病（OR 3.719，p<0.01，95%CI 1.70 - 8.17）和体重减轻（OR 4.408，p<0.01，95%CI 1.92 - 10.10）。最常见的再入院诊断组为双相情感障碍（8.2%）、术后、创伤后或其他器械感染（6.2%）、重度抑郁症和其他/未特定的精神病（5.2%）。
儿科攻击后的再入院代表了巨大的资源负担；这些患者中近四分之一在再次攻击后再次入院。了解儿科创伤攻击受害者再入院的风险因素和原因可以改善出院计划、家庭教育和门诊支持，从而降低总体成本和资源负担。精神病、体重减轻和住院时间延长是儿科攻击患者再入院的独立预后指标。
IV级 - 预后和流行病学 - 回顾性研究。
