Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Pediatric Neurology, Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania; Pediatric Neurology Health Services Research Group, Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania.
Pediatr Neurol. 2020 Jul;108:93-98. doi: 10.1016/j.pediatrneurol.2020.01.010. Epub 2020 Feb 7.
The burden and characteristics of unplanned readmission after epilepsy-related discharge in children in the United States is not known.
We undertook a retrospective cohort study of children aged one to 17 years discharged after a nonelective hospitalization for epilepsy, sampled from the Healthcare Cost and Utilization Project's 2013 and 2014 Nationwide Readmissions Database. Descriptive statistics and logistic regression models were used to examine the characteristics of initial hospitalization and risk factors for readmission.
A total of 42,873 admissions for unique patients were identified, with 4470 (10.4%) leading to readmission within 30 days. The most common readmission diagnosis was epilepsy (24.9%). Neurodevelopmental diagnoses including cerebral palsy, intellectual disability, and developmental delay were associated with increased odds of readmission. Longer hospitalization, gastrostomy, and tracheostomy were also associated with readmission, but continuous electroencephalography use was not. Children insured by Medicare had a readmission rate of 34.4%, whereas there were no associations of readmission with other sociodemographic characteristics such as neighborhood, income, and sex.
Seizures are among the most frequent reasons for hospitalization in children. Establishing a benchmark readmission rate for pediatric epilepsy of 10.4% may be useful to health systems designing quality improvement efforts. Clinical factors were more strongly associated with readmission than demographic characteristics. Interventions to reduce pediatric epilepsy readmissions may have the highest yield when targeting children with neurodevelopmental comorbidities.
在美国，儿童癫痫相关出院后的非计划性再入院的负担和特征尚不清楚。
我们对 2013 年和 2014 年全美再入院数据库中因癫痫非择期住院后出院的 1 至 17 岁儿童进行了回顾性队列研究。使用描述性统计和逻辑回归模型来检查初始住院的特征和再入院的危险因素。
共确定了 42873 例独特患者的入院，其中 4470 例（10.4%）在 30 天内再入院。最常见的再入院诊断是癫痫（24.9%）。包括脑瘫、智力残疾和发育迟缓在内的神经发育诊断与再入院的几率增加相关。住院时间延长、胃造口术和气管造口术也与再入院相关，但连续脑电图的使用与再入院无关。医疗保险覆盖的儿童再入院率为 34.4%，而再入院与邻里、收入和性别等其他社会人口特征没有关联。
癫痫发作是儿童住院的最常见原因之一。为儿科癫痫建立 10.4%的基准再入院率对于设计质量改进措施的卫生系统可能是有用的。临床因素与再入院的相关性强于人口统计学特征。针对患有神经发育合并症的儿童采取干预措施，可能会最大程度地减少儿科癫痫再入院。
