Department of Pediatrics, University of Illinois College of Medicine at Peoria, Illinois;
School of Medicine, University of Kansas, Wichita, Kansas.
Hosp Pediatr. 2021 Jul;11(7):662-670. doi: 10.1542/hpeds.2020-005794.
Although a growing body of evidence suggests that early transition to oral antimicrobial therapy is equally efficacious to prolonged intravenous antibiotics for treatment of acute pediatric osteomyelitis, little is known about the pediatric trends in peripherally inserted central catheter (PICC) placements. Using a national database, we examined incidence rates of pediatric hospitalizations for acute osteomyelitis in the United States from 2007 through 2016, as well as the trends in PICC placement, length of stay (LOS), and cost associated with these hospitalizations.
This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 through 2016. Patients ≤18 years of age with acute osteomyelitis were identified by using appropriate diagnostic codes. Outcomes measured included PICC placement rate, LOS, and inflation-adjusted hospitalization costs. Weighted analysis was reported, and a hierarchical regression model was used to analyze predictors.
The annual incidence of acute osteomyelitis increased from 1.0 to 1.8 per 100 000 children from 2007 to 08 to 2015 to 16 ( < .0001), whereas PICC placement rates decreased from 58.8% to 5.9% ( < .0001). Overall, changes in LOS and inflation-adjusted hospital costs were not statistically significant. PICC placements and sepsis were important predictors of increased LOS and hospital costs.
Although PICC placement rates for acute osteomyelitis significantly decreased in the face of increased incidence of acute osteomyelitis in children, LOS and hospital costs for all hospitalizations remained stable. However, patients receiving PICC placements had longer LOS. Further studies are needed to explore the long-term outcomes of reduced PICC use.
尽管越来越多的证据表明，早期转为口服抗菌治疗与延长静脉抗生素治疗急性小儿骨髓炎同样有效，但对于小儿外周插入中心导管（PICC）置管的趋势知之甚少。本研究使用国家数据库，在美国，我们检查了 2007 年至 2016 年期间急性骨髓炎住院的儿童发生率，以及 PICC 置管、住院时间（LOS）和与这些住院相关的费用的趋势。
这是一项回顾性、连续的国家住院患者样本数据库研究，时间为 2007 年至 2016 年。通过使用适当的诊断代码，确定≤18 岁患有急性骨髓炎的患者。测量的结果包括 PICC 置管率、LOS 和通胀调整后的住院费用。报告了加权分析，并使用层次回归模型分析了预测因素。
急性骨髓炎的年发病率从 2007 年至 08 年至 2015 年至 16 年从每 100000 名儿童 1.0 例增加到 1.8 例（<0.0001），而 PICC 置管率从 58.8%下降到 5.9%（<0.0001）。总体而言，LOS 和通胀调整后住院费用的变化没有统计学意义。PICC 置管和败血症是 LOS 和住院费用增加的重要预测因素。
尽管小儿急性骨髓炎的 PICC 置管率显著下降，但面对小儿急性骨髓炎发病率的增加，所有住院患者的 LOS 和住院费用仍保持稳定。然而，接受 PICC 置管的患者 LOS 更长。需要进一步研究来探讨减少 PICC 使用的长期结果。
