Prout Andrew J, Talisa Victor B, Carcillo Joseph A, Angus Derek C, Chang Chung-Chou H, Yende Sachin
Clinical Research, Investigation, and Systems Modeling of Acute Illness Center.
Departments of Critical Care Medicine and.
Hosp Pediatr. 2019 Apr;9(4):249-255. doi: 10.1542/hpeds.2018-0175. Epub 2019 Mar 1.
The decline in hospital mortality in children hospitalized with sepsis has increased the number of survivors. These survivors are at risk for adverse long-term outcomes, including readmission and recurrent or unresolved infections. We described the epidemiology of 90-day readmissions after sepsis hospitalization in children. We tested the hypothesis that a sepsis hospitalization increases odds of 90-day readmissions.
Retrospective cohort analysis of the Nationwide Readmissions Database. We included index unplanned admissions of non-neonatal pediatric patients and described the proportion of readmissions, including those involving infection or sepsis. We performed multivariable analysis to determine the odds of readmission after a sepsis and nonsepsis admission and compared costs of readmission after sepsis and nonsepsis admissions.
Of 562 817 pediatric admissions, 7634 (1.4%) and 555 183 (98.6%) were discharged alive after admissions with and without sepsis. The rate of 90-day readmission after sepsis was 21.4%: 7.2% and 25.5% in previously healthy and chronically ill patients. The adjusted mean cost during readmission was $7385. Half of readmissions (52.9%) involved recurrent infection or sepsis. Sepsis admissions were associated with higher odds of readmission at 90 days compared with nonsepsis admissions (adjusted odds ratio 1.15, 95% confidence interval 1.08-1.23). The results remained unchanged for 30-day and 6-month readmissions.
Readmissions occur after 1 in 5 pediatric sepsis hospitalizations and increase health care costs. Sepsis hospitalization increased odds of readmission and commonly involved recurrent infection or sepsis. Clinicians caring for these patients should consider surveillance for recurrent or unresolved infection, and researchers should explore underlying mechanisms and potential interventions to reduce readmissions.
因脓毒症住院的儿童患者院内死亡率的下降使得存活者数量增加。这些存活者面临着长期不良结局的风险，包括再次入院以及反复感染或感染未愈。我们描述了儿童脓毒症住院后90天内再入院的流行病学情况。我们检验了脓毒症住院会增加90天内再入院几率这一假设。
对全国再入院数据库进行回顾性队列分析。我们纳入了非新生儿儿科患者的首次非计划入院病例，并描述了再入院的比例，包括那些涉及感染或脓毒症的病例。我们进行了多变量分析，以确定脓毒症和非脓毒症入院后再入院的几率，并比较了脓毒症和非脓毒症入院后再入院的费用。
在562817例儿科入院病例中，因脓毒症入院和未因脓毒症入院后存活出院的病例分别为7634例（1.4%）和555183例（98.6%）。脓毒症后90天再入院率为21.4%：既往健康和慢性病患者分别为7.2%和25.5%。再入院期间调整后的平均费用为7385美元。一半的再入院病例（52.9%）涉及反复感染或脓毒症。与非脓毒症入院相比，脓毒症入院90天时再入院几率更高（调整后的优势比为1.15，95%置信区间为1.08 - 1.23）。30天和6个月再入院的结果保持不变。
每5例儿童脓毒症住院病例中就有1例发生再入院，且增加了医疗费用。脓毒症住院增加了再入院几率，且通常涉及反复感染或脓毒症。照顾这些患者的临床医生应考虑对反复感染或未愈感染进行监测，研究人员应探索潜在机制和干预措施以减少再入院情况。
