Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; and
Departments of Pediatrics and.
Hosp Pediatr. 2020 Jun;10(6):481-488. doi: 10.1542/hpeds.2019-0236.
Technology-dependent children (TDC) are admitted to both children's hospitals (CHs) and nonchildren's hospitals (NCHs), where there may be fewer pediatric-specific specialists or resources. Our objective was to compare the characteristics of TDC admitted to CHs versus NCHs.
This was a multicenter, retrospective study using the 2012 Kids' Inpatient Database. We included patients aged 0 to 18 years with a tracheostomy, gastrostomy, and/or ventricular shunt. We excluded those who died, were transferred into or out of the hospital, had a length of stay (LOS) that was an extreme outlier, or had missing data for key variables. We compared patient and hospital characteristics across CH versus NCH using χ tests and LOS and cost using generalized linear models.
In the final sample of 64 521 discharges, 55% of discharges of TDC were from NCHs. A larger proportion of those from CHs had higher disease severity (55% vs 49%; < .001) and a major surgical procedure during hospitalization (28% vs 24%; < .001). In an adjusted generalized linear model, the mean LOS was 4 days at both hospital types, but discharge from a CH was associated with a higher adjusted mean cost ($16 754 vs $12 023; < .001).
Because the majority of TDC are hospitalized at NCHs, future research on TDC should incorporate NCH settings. Further studies should investigate if some may benefit from regionalization of care or earlier transfer to a CH.
依赖技术的儿童（TDC）既被收入儿童医院（CH）也被收入非儿童医院（NCH），而 NCH 中可能儿科专科医生或资源较少。我们的目的是比较收入 CH 和 NCH 的 TDC 的特征。
这是一项多中心、回顾性研究，使用了 2012 年的儿童住院数据库。我们纳入了年龄在 0 至 18 岁之间、有气管造口术、胃造口术和/或脑室分流术的患者。我们排除了那些死亡、转院或出院、住院时间（LOS）为极端离群值或关键变量缺失数据的患者。我们使用 χ2 检验和广义线性模型比较了 CH 与 NCH 之间的患者和医院特征以及 LOS 和费用。
在最终的 64521 例出院患者中，55%的 TDC 出院是在 NCH。来自 CH 的患者中有更高比例的疾病严重程度（55%比 49%；<0.001）和住院期间主要手术（28%比 24%；<0.001）。在调整后的广义线性模型中，两种医院类型的平均 LOS 均为 4 天，但从 CH 出院与更高的调整后平均费用相关（$16754 比 $12023；<0.001）。
由于大多数 TDC 是在 NCH 住院治疗，未来关于 TDC 的研究应纳入 NCH 环境。进一步的研究应该调查是否有些患者可能受益于护理的区域化或更早地转至 CH。
