From the Division of Child Neurology (A.H., Y.S., S. Karkare, S. Kothare), Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY; and Department of Pediatrics (K.S.), University of Massachusetts Medical School, Worcester.
Neurology. 2019 Apr 16;92(16):e1926-e1932. doi: 10.1212/WNL.0000000000007280. Epub 2019 Mar 20.
Hospital readmission is an important quality improvement measure that has not been well-studied in pediatric neurology. We examined predictors of 7-day and 30-day readmissions for pediatric patients hospitalized with a neurologic diagnosis.
This was a retrospective study of hospital readmission rates in pediatric neurology patients admitted to a tertiary children's hospital from January 2017 to December 2017. Inclusion criteria were age ≤18 years and a primary neurologic diagnosis on admission, with an unplanned readmission within 7 or 30 days. Demographic and clinical data were collected, including age, sex, income, insurance type, discharge occurring on a weekend, admission to the pediatric intensive care unit (PICU), use of multiple antiepileptic drugs (AEDs), and involvement of multiple subspecialties.
There were 923 neurology admissions, and 64 readmissions within 30 days. Total unplanned readmission rate was 6.9%, with 56% (36/64) readmitted within 30 days, 44% (28/64) readmitted within 7 days, and 11% (7/64) admitted multiple times within 30 days. The most common readmission diagnosis was seizure (62%), followed by other neurologic diagnosis (21%), headache (8%), encephalitis/meningitis (7%), stroke (1%), and ataxia (1%). Readmission was significantly associated with multiple AED, PICU admission, seizure with major complication or comorbidity, and presence of a major complication or comorbidity irrespective of diagnosis ( < 0.05).
This study identifies factors associated with higher rates of readmission for pediatric neurology patients. Patients with epilepsy and chronic neurologic conditions should be targeted for future discharge-related interventions to reduce hospital readmission and ensure safe transitions from the inpatient to the outpatient setting.
医院再入院是一个重要的质量改进指标，但在儿科神经病学领域研究甚少。我们研究了儿科神经病学患者住院期间因神经系统诊断而在 7 天和 30 天内再入院的预测因素。
这是一项对 2017 年 1 月至 2017 年 12 月期间在一家三级儿童医院因神经系统诊断住院的儿科神经病学患者再入院率的回顾性研究。纳入标准为年龄≤18 岁，入院时的主要诊断为神经系统疾病，且在 7 天或 30 天内发生计划外再入院。收集了人口统计学和临床数据，包括年龄、性别、收入、保险类型、周末出院、入住儿科重症监护病房（PICU）、使用多种抗癫痫药物（AEDs）以及涉及多个亚专科。
共纳入 923 例神经病学住院患者，30 天内有 64 例再入院。总计划外再入院率为 6.9%，其中 56%（36/64）在 30 天内再入院，44%（28/64）在 7 天内再入院，11%（7/64）在 30 天内多次入院。最常见的再入院诊断为癫痫（62%），其次为其他神经系统诊断（21%）、头痛（8%）、脑炎/脑膜炎（7%）、中风（1%）和共济失调（1%）。再入院与使用多种 AED、入住 PICU、伴有严重并发症或合并症的癫痫发作以及存在严重并发症或合并症无关（<0.05）。
本研究确定了与儿科神经病学患者再入院率较高相关的因素。应针对癫痫和慢性神经系统疾病患者进行未来的出院相关干预，以降低医院再入院率，并确保从住院到门诊的安全过渡。
