From the Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
ASAIO J. 2022 Aug 1;68(8):1074-1082. doi: 10.1097/MAT.0000000000001603. Epub 2021 Nov 3.
There are minimal data describing outcomes in ambulatory pediatric and young adult ventricular assist device (VAD)-supported patient populations. We performed a retrospective analysis of encounter-level data from 2006 to 2017 Nationwide Emergency Department Sample (NEDS) to compare emergency department (ED) resource utilization and outcomes for pediatric (≤18 years, n = 494) to young adult (19-29 years, n = 2,074) VAD-supported patient encounters. Pediatric encounters were more likely to have a history of congenital heart disease (11.3% vs. 4.8%). However, Pediatric encounters had lower admission/transfer rates (37.8% vs. 57.8%) and median charges ($3,334 (IQR $1,473-$19,818) vs. $13,673 ($3,331-$45,884)) (all p < 0.05). Multivariable logistic regression modeling revealed that age itself was not a predictor of admission, instead high acuity primary diagnoses and medical complexity were: (adjusted odds ratio; 95% confidence intervals): cardiac (3.0; 1.6-5.4), infection (3.4; 1.7-6.5), bleeding (3.9; 1.7-8.8), device complication (7.2; 2.7-18.9), and ≥1 chronic comorbidity (4.1; 2.5-6.7). In this largest study to date describing ED resource use and outcomes for pediatric and young adult VAD-supported patients, we found that, rather than age, high acuity presentations and comorbidities were primary drivers of clinical outcomes. Thus, reducing morbidity in this population should target comorbidities and early recognition of VAD-related complications.
关于门诊儿科和青年成年心室辅助装置 (VAD) 支持患者人群的结果，数据很少。我们对 2006 年至 2017 年全国急诊部样本 (NEDS) 的就诊水平数据进行了回顾性分析，以比较儿科 (≤18 岁，n=494) 和青年成年 (19-29 岁，n=2074) VAD 支持患者就诊的急诊部 (ED) 资源利用和结局。儿科就诊者更有可能有先天性心脏病史 (11.3%比 4.8%)。然而，儿科就诊者的入院/转科率较低 (37.8%比 57.8%)，且平均费用较低 (3334 美元 (IQR 1473-19818 美元) 比 13673 美元 ($3331-45884 美元)) (均 P<0.05)。多变量逻辑回归模型显示，年龄本身并不是入院的预测因素，而是高急症主要诊断和医疗复杂性：(调整后的优势比；95%置信区间)：心脏 (3.0；1.6-5.4)，感染 (3.4；1.7-6.5)，出血 (3.9；1.7-8.8)，设备并发症 (7.2；2.7-18.9)，以及 ≥1 种慢性合并症 (4.1；2.5-6.7)。在这项迄今为止描述儿科和青年成年 VAD 支持患者急诊部资源利用和结局的最大研究中，我们发现，与年龄相比，高急症表现和合并症是临床结局的主要驱动因素。因此，减少该人群的发病率应针对合并症和 VAD 相关并发症的早期识别。
