General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia.
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
BMJ Open. 2019 Jan 28;9(1):e020554. doi: 10.1136/bmjopen-2017-020554.
To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs).
Systematic review.
CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017.
Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included.
Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form.
Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS.
This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
综合有关儿科非计划性住院再入院（UHR）相关危险因素的证据。
系统评价。
2000 年至 2017 年，CINAHL、EMBASE（Ovid）和 MEDLINE。
发表在英文期刊上且全文可获取、并聚焦于儿科全因、手术操作和一般医疗状况相关 UHR 的研究。
提取纳入研究的特征、研究变量和具有统计学意义的危险因素。两位审查员基于潜在偏倚的六个领域独立评估研究质量。由于纳入研究存在异质性，不允许对提取的危险因素进行合并。使用内容分析对数据进行综合，并以叙述形式呈现。
从 44 项纳入研究中提取了 36 个显著的危险因素，并根据三个健康状况分组进行了呈现。对于全因 UHR，种族、合并症和健康保险类型是最常被提及的因素。对于手术操作相关 UHR，特定的手术操作、合并症、住院时间（LOS）、年龄、美国麻醉医师协会分类、术后并发症、手术持续时间、健康保险类型和疾病严重程度是更为常见的危险因素。与一般医疗状况相关 UHR 相关的四个最常被提及的危险因素是合并症、年龄、索引入院前的卫生服务使用情况和 LOS。
本系统评价承认预测儿科人群再入院风险的复杂性。本综述在所有三个健康状况分组中确定了四个危险因素，即合并症、公共健康保险、较长的 LOS 以及<12 个月或 13-18 岁的患者。然而，危险因素的识别取决于纳入研究中检查的变量。在将报告的危险因素推广到其他机构时，应考虑这些因素。本综述强调需要制定一套标准化的措施，以捕捉预测儿科患者非计划性再入院的关键出院变量。
