Russell Christopher J, Mamey Mary R, Koh Joyce Y, Schrager Sheree M, Neely Michael N, Wu Susan
Divisions of Hospital Medicine and
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
Hosp Pediatr. 2018 Jan 16;8(2):72-80. doi: 10.1542/hpeds.2017-0106.
To identify factors associated with longer length of stay (LOS) and higher 30-day hospital revisit rates for children hospitalized with bacterial tracheostomy-associated respiratory tract infections (bTARTIs).
This was a multicenter, retrospective cohort study using administrative data from the Pediatric Health Information System database between 2007 and 2014 of patients 30 days to 17 years old with a principal discharge diagnosis of bTARTI or a principal discharge diagnosis of bTARTI symptoms with a secondary diagnosis of bTARTI. Primary outcomes of LOS (in days) and 30-day all-cause revisit rates (inpatient, observation, or emergency department visit) were analyzed by using a 3-level hierarchical regression model (discharges within patients within hospital).
We included 3715 unique patients and 7355 discharges. The median LOS was 4 days (interquartile range: 3-8 days), and the 30-day revisit rate was 30.5%. Compared with children 1 to 4 years old, children aged 30 days to 12 months had both longer LOS (adjusted length of stay [aLOS] = +0.9 days; 95% confidence interval [CI]: 0.6 to 1.3) and increased hospital revisit risk (adjusted odds ratio [aOR] = 1.5; 95% CI: 1.3 to 1.7). Other factors associated with longer LOS included public insurance (aLOS = +0.5 days; 95% CI: 0.2 to 0.8), 3 or more complex chronic conditions (CCCs), mechanical ventilation (acute or chronic), and empirical anti- antibiotics (aLOS = +0.6 days; 95% CI: 0.3 to 0.9). Other factors associated with 30-day revisit included 4 or more CCCs (aOR = 1.3; 95% CI: 1.1 to 1.6) and chronic ventilator dependency (aOR = 1.1; 95% CI: 1.0 to 1.3).
Ventilator-dependent patients <12 months old with at least 4 CCCs are at highest risk for both longer LOS and 30-day revisit after discharge for bTARTIs. They may benefit from bTARTI prevention strategies and intensive care coordination while hospitalized.
确定与细菌性气管造口术相关呼吸道感染（bTARTIs）住院儿童住院时间延长和30天内医院再入院率较高相关的因素。
这是一项多中心回顾性队列研究，使用2007年至2014年期间儿科健康信息系统数据库中的管理数据，研究对象为30天至17岁的患者，主要出院诊断为bTARTI或主要出院诊断为bTARTI症状且次要诊断为bTARTI。使用三级分层回归模型（医院内患者出院情况）分析住院时间（以天为单位）和30天全因再入院率（住院、观察或急诊就诊）的主要结局。
我们纳入了3715名独特患者和7355次出院。中位住院时间为4天（四分位间距：3 - 8天），30天再入院率为30.5%。与1至4岁儿童相比，30天至12个月大的儿童住院时间更长（调整后住院时间[aLOS]= +0.9天；95%置信区间[CI]：0.6至1.3）且医院再入院风险增加（调整后优势比[aOR]= 1.5；95%CI：1.3至1.7）。与住院时间延长相关的其他因素包括公共保险（aLOS = +0.5天；95%CI：0.2至0.8）、3种或更多复杂慢性病（CCCs）、机械通气（急性或慢性）以及经验性使用抗生素（aLOS = +0.6天；95%CI：0.3至0.9）。与30天再入院相关的其他因素包括4种或更多CCCs（aOR = 1.3；95%CI：1.1至1.6）和慢性呼吸机依赖（aOR = 1.1；95%CI：1.0至1.3）。
年龄小于12个月、依赖呼吸机且患有至少4种CCCs的患者，因bTARTIs出院后住院时间延长和30天内再入院的风险最高。他们在住院期间可能受益于bTARTI预防策略和重症监护协调。
