Boston Medical Center, Boston, Massachusetts;
Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Hosp Pediatr. 2020 May;10(5):415-423. doi: 10.1542/hpeds.2019-0226. Epub 2020 Apr 8.
The appropriateness of interfacility transfer admissions for bronchiolitis to pediatric centers is uncertain. We characterized avoidable transfer admissions for bronchiolitis. We hypothesized that a higher proportion of hospitalized infants transferred from a community emergency department (ED) or hospital (transfer admission) would be discharged within 48 hours with little or no intervention, compared with direct admissions from an enrolling ED (nontransfer admission).
We analyzed a 17-center, prospective infant cohort (age <1 year) hospitalized for bronchiolitis (2011-2014). An avoidable transfer admission (primary outcome) was hospitalization for <48 hours without an intervention for severe illness in which a pediatric specialist could be beneficial (oxygen, advanced airway management, life support). Parenteral fluids and routine medications were excluded. We compared admissions by patient, ED, inpatient, and transferring hospital characteristics to identify factors associated with avoidable transfer admissions. Multivariable logistic regression was used to identify predictors of avoidable transfer admission.
Among 1007 infants, 558 (55%) were nontransfer admissions, 164 (16%) were transfer admissions, and 204 (20%) were referrals from clinics; 81 (8%) were missing referral type. Significantly fewer transferred infants were hospitalized for <48 hours with little or no intervention (40 of 164; 24% [95% confidence interval 18%-32%]) than nontransferred infants (199 of 558; 36% [95% confidence interval 32%-40%]; = .007). Avoidable transfer admissions were more likely to be children of color, have nonprivate insurance, receive fewer ED interventions, and originate from small EDs. A multivariable model revealed that minority race and/or ethnicity, normal oxygenation, and small ED transfers increased odds of avoidable transfer admission.
Although most transferred infants hospitalized for bronchiolitis required interventions for severe illness, 1 in 4 admissions were potentially avoidable.
毛细支气管炎患儿转至儿科中心的适应证并不明确。本研究旨在明确毛细支气管炎患儿中转诊入院的可避免性。我们假设，与直接从参与研究的急诊室（ED）入院的患儿（直接入院）相比，从社区 ED 或医院（转入入院）转入的住院婴儿中，有更高比例的患儿在入院后 48 小时内出院，且干预较少或几乎无需干预。
我们分析了 17 家中心、前瞻性婴儿队列（年龄＜1 岁）的毛细支气管炎住院患儿（2011-2014 年）。可避免性的转院入院（主要结局）是指住院时间＜48 小时，且患儿无严重疾病需要干预（例如需要吸氧、高级气道管理、生命支持），但不包括静脉补液和常规药物治疗。我们比较了患者、ED、住院和转院特征，以确定与可避免性转院入院相关的因素。采用多变量逻辑回归确定可避免性转院入院的预测因素。
在 1007 名婴儿中，558 名（55%）为非转院入院，164 名（16%）为转院入院，204 名（20%）为来自诊所的转诊，81 名（8%）未记录转诊类型。与非转院入院患儿相比，转入入院的患儿住院时间＜48 小时且干预较少或几乎无需干预的比例明显更低（164 例患儿中有 40 例，24%[95%置信区间 18%-32%]；558 例患儿中有 199 例，36%[95%置信区间 32%-40%]； =.007）。可避免性转院入院患儿更有可能是有色人种，有非私人保险，在 ED 接受的干预较少，来自较小的 ED。多变量模型显示，少数族裔、正常氧合和较小的 ED 转院会增加可避免性转院入院的几率。
尽管大多数因毛细支气管炎而住院的转入患儿需要针对严重疾病进行干预，但仍有 1/4 的入院可能是可以避免的。
