Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas.
Hosp Pediatr. 2021 Apr;11(4):366-373. doi: 10.1542/hpeds.2020-001230.
To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS.
For this retrospective cross-sectional study, we used the National Inpatient Sample. We included children <18 years old hospitalized with a primary or secondary diagnosis of SI or SA who were dispositioned to psychiatric facilities from 2016 to 2017. Exposures were patient sociodemographics, underlying mental health diagnoses, and hospital characteristics. Our outcome was pLOS. Adjusted prevalence ratios with 95% confidence intervals (CIs) were generated with log binomial regression.
Of 12 715 hospitalizations meeting inclusion criteria, 5475 had pLOS. After adjusting for sociodemographics and hospital characteristics, predictive factors for pLOS were public insurance use (prevalence ratio: 1.40; CI: 1.12-1.78), urban nonteaching hospital location (prevalence ratio: 4.61; CI: 2.33-9.12), urban teaching hospital location (prevalence ratio: 3.26; CI: 1.84-5.76), and underlying diagnosis of mood disorder (prevalence ratio: 1.98; CI: 1.63-3.42). Hispanic patients had decreased probability of pLOS (prevalence ratio: 0.69; CI: 0.52-0.93). Otherwise, age, zip income, sex, and hospital region were not predictive of pLOS.
Among children hospitalized for SI or SA requiring transfer to psychiatric facilities, public insurance, urban hospital location, and diagnoses of mood disorder, depression, and bipolar disorder were predictive of pLOS. Further research is needed on how to decrease disparities in length of stay among this vulnerable population.
确定社会人口因素或潜在心理健康状况是否可作为因自杀意念（SI）或自杀未遂（SA）而住院并需要转至精神科医疗机构的儿童延长住院时间（pLOS）的预测因素。我们假设某些患者和医院特征与 pLOS 之间存在关联。
在这项回顾性的病例交叉研究中，我们使用了全国住院患者样本。我们纳入了 2016 年至 2017 年期间因 SI 或 SA 被收治入院、并被转至精神科医疗机构的年龄在 18 岁以下的儿童患者。暴露因素包括患者的社会人口统计学特征、潜在的心理健康诊断和医院特征。我们的结局是 pLOS。采用对数二项式回归生成调整后的患病率比（95%置信区间[CI]）。
在符合纳入标准的 12715 例住院患者中，有 5475 例存在 pLOS。在校正了社会人口统计学和医院特征后，pLOS 的预测因素为公共保险的使用（患病率比：1.40；95%CI：1.12-1.78）、城市非教学医院的位置（患病率比：4.61；95%CI：2.33-9.12）、城市教学医院的位置（患病率比：3.26；95%CI：1.84-5.76）和潜在的心境障碍诊断（患病率比：1.98；95%CI：1.63-3.42）。西班牙裔患者的 pLOS 可能性降低（患病率比：0.69；95%CI：0.52-0.93）。否则，年龄、邮政编码收入、性别和医院所在地区与 pLOS 无关。
在因 SI 或 SA 而住院并需要转至精神科医疗机构的儿童中，公共保险、城市医院的位置以及心境障碍、抑郁症和双相情感障碍的诊断与 pLOS 相关。需要进一步研究如何减少这一弱势群体的住院时间差异。
