Wheeler Krista K, Shi Junxin, Nordin Andrew B, Xiang Henry, Groner Jonathan I, Fabia Renata, Thakkar Rajan K
Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
J Burn Care Res. 2018 Jan 1;39(1):73-81. doi: 10.1097/BCR.0000000000000596.
The objectives of the study were to determine unscheduled 30-day readmission rates for pediatric burn patients and to identify readmission reasons. We used the 2013-2014 National Readmission Database to produce 30-day all-cause unscheduled readmission rates by patient and hospital characteristics. Readmission risk factors were evaluated with multivariable logistic regression. An estimated 11,940 U.S. pediatric burn patients were discharged in January through November 2013 and 2014, and 325 had unscheduled readmissions within 30 days (2.7%; 95% confidence interval [CI], 1.5-3.9). This rate is higher than that seen in pediatric trauma patients (1.7%; P = 0.04]. Higher rates were seen in children with TBSA burned ≥ 10% (4.1%; 95% CI, 2.3-6.0) and patients with third-degree burns (5.5%; 95% CI, 1.4-9.6). The majority (86%) had index admissions in hospitals treating 100 or more burn patients annually, and 98% returned to the same hospital. Over two-thirds had an operating room procedure during their readmission; 15% had infections. The highest adjusted odds of readmission (AOR = 2.7; 95% CI, 1.7-4.2) was for patients with third-degree burns. When compared with patients with lengths of stay (LOS) of 1 day, those with LOS of 2 to 3 days had a higher odds (AOR = 1.7; 95% CI, 1.03-2.9), but the AOR was not different for those with LOS > 3 days. TBSA, index operating room procedure, and patient residence were associated with readmission. This national dataset enhances our ability to predict patients at risk for unscheduled readmission and to plan for appropriate patient discharge, potentially reducing readmissions.
本研究的目的是确定小儿烧伤患者30天非计划再入院率，并找出再入院原因。我们使用2013 - 2014年全国再入院数据库，按患者和医院特征得出30天全因非计划再入院率。通过多变量逻辑回归评估再入院风险因素。2013年1月至2014年11月期间，估计有11940名美国小儿烧伤患者出院，其中325人在30天内非计划再入院（2.7%；95%置信区间[CI]，1.5 - 3.9）。这一比率高于小儿创伤患者（1.7%；P = 0.04）。烧伤总面积（TBSA）≥10%的儿童（4.1%；95% CI，2.3 - 6.0）和三度烧伤患者（5.5%；95% CI，1.4 - 9.6）的再入院率更高。大多数（86%）患者首次入院于每年收治100名或更多烧伤患者的医院，98%的患者返回同一家医院。超过三分之二的患者在再入院期间接受了手术室手术；此外，15%的患者发生了感染。三度烧伤患者再入院的调整后优势比最高（AOR = 2.7；95% CI，1.7 - 4.2）。与住院时间（LOS）为1天的患者相比，住院时间为2至3天的患者优势比更高（AOR = 1.7；95% CI，1.03 - 2.9），但住院时间>3天的患者AOR无差异。TBSA、首次手术室手术和患者居住地与再入院有关。这个全国性数据集增强了我们预测非计划再入院风险患者以及规划适当患者出院的能力，有可能减少再入院情况。
