Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC, Orange, California, USA.
Children's Hospital of Orange County (CHOC), Orange, California, USA.
BMC Neurol. 2021 Jan 5;21(1):5. doi: 10.1186/s12883-020-02028-0.
Unplanned readmission is one of many measures of the quality of care of pediatric patients with neurological conditions. In this multicenter study, we searched for novel risk factors of readmission of patients with neurological conditions.
We retrieved hospitalization data of patients less than 18 years with one or more neurological conditions. This resulted in a total of 105,834 encounters from 18 hospitals. We included data on patient demographics, prior healthcare resource utilization, neurological conditions, number of other conditions/diagnoses, number of medications, and number of surgical procedures performed. We developed a random intercept logistic regression model using stepwise minimization of Akaike Information Criteria for variable selection.
The most important neurological conditions associated with unplanned pediatric readmissions include hydrocephalus, inflammatory diseases of the central nervous system, sleep disorders, disease of myoneural junction and muscle, other central nervous system disorder, other spinal cord conditions (such as vascular myelopathies, and cord compression), and nerve, nerve root and plexus disorders. Current and prior healthcare resource utilization variables, number of medications, other diagnoses, and certain inpatient surgical procedures were associated with changes in odds of readmission. The area under the receiver operator characteristic curve (AUROC) on the independent test set is 0.733 (0.722, 0.743).
Pediatric patients with certain neurological conditions are more likely to be readmitted than others. However, current and prior healthcare resource utilization remain some of the strongest indicators of readmission within this population as in the general pediatric population.
计划外再入院是衡量儿科神经科患者护理质量的众多指标之一。在这项多中心研究中，我们寻找了导致神经科疾病患者再入院的新的危险因素。
我们检索了 18 家医院年龄小于 18 岁、患有一种或多种神经科疾病的患者的住院数据。这总计产生了 105834 例就诊记录。我们纳入了患者人口统计学资料、先前的医疗资源利用情况、神经科疾病、其他疾病/诊断数量、药物种类和手术操作数量的数据。我们使用逐步最小化赤池信息量准则（Akaike Information Criterion）的随机截距逻辑回归模型进行变量选择。
与计划外儿科再入院最相关的重要神经科疾病包括脑积水、中枢神经系统炎症性疾病、睡眠障碍、神经肌肉接头和肌肉疾病、其他中枢神经系统疾病、其他脊髓疾病（如血管性脊髓病和脊髓压迫）、以及神经、神经根和神经丛疾病。当前和先前的医疗资源利用变量、药物种类、其他诊断和某些住院手术操作与再入院几率的变化相关。独立测试集上的受试者工作特征曲线（receiver operating characteristic curve，ROC）下面积（area under the receiver operating characteristic curve，AUROC）为 0.733（0.722，0.743）。
某些神经科疾病的儿科患者比其他患者更有可能再入院。然而，在这个人群中，如同一般儿科人群一样，当前和先前的医疗资源利用情况仍然是再入院的最强预测指标之一。
