Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
J Pediatr. 2022 Jul;246:161-169.e7. doi: 10.1016/j.jpeds.2022.03.040. Epub 2022 Mar 29.
To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization.
We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010 to June 2020. Our primary outcome was death during readmission within 180 days of an index hospitalization among children aged 0-18 years. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group-categorized illness severity (ie, minor, moderate, or major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission.
Among 2 677 111 children discharged, 337 385 (12.6%) were readmitted within 180 days of the index hospitalization and 2913 (0.8%) died during readmission. More than one-quarter (26.2%) of deaths among children who were readmitted and died occurred within 10 days after discharge from the index hospitalization. Factors independently associated with mortality during readmission included multiple complex chronic conditions, index admissions lasting >7 days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission compared with children of other races.
Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.
确定与住院后 180 天内再入院相关的人口统计学、临床和医院因素与死亡率的关系。
我们进行了一项回顾性队列研究，纳入了 2010 年 1 月至 2020 年 6 月期间来自美国 33 家儿童医院的儿科健康信息系统数据。我们的主要结局是在索引住院后 180 天内再次入院期间 0-18 岁儿童的死亡。索引住院期间的疾病严重程度根据所有患者细化诊断相关组（All Patient-Refined Diagnosis-Related Group，APR-DRG）分类的疾病严重程度（轻度、中度或重度/极重度）定义。我们进行了多变量逻辑回归分析，以确定索引住院期间与再入院期间死亡率相关的因素。
在出院的 2677111 名儿童中，有 337385 名（12.6%）在索引住院后 180 天内再次入院，2913 名（0.8%）在再入院期间死亡。在再次入院和死亡的儿童中，超过四分之一（26.2%）的死亡发生在索引住院出院后 10 天内。与再入院期间死亡相关的独立因素包括多种复杂的慢性疾病、索引住院持续时间超过 7 天、索引住院期间的中度或重度/极重度疾病以及公共保险。与其他种族的儿童相比，报告为黑人的儿童再入院期间死亡的可能性更高。
在住院儿童中，索引住院期间的一些人口统计学和临床因素与再入院期间的死亡率相关。报告为黑人的儿童再入院期间死亡的可能性更高，这可能反映了健康和临床护理的社会决定因素方面的差异。减少再入院期间死亡率的干预措施可能针对出院后立即的高危人群。
