Half of all readmissions following lower respiratory infections occur in infants

1. Boys, infants <1 year of age, and children with chronic conditions were found to be more likely to be readmitted within 30 days following hospitalization for lower respiratory infections (LRIs).

2. Readmissions following LRI hospitalization varied widely among hospitals, and were most likely attributed to continued LRI, asthma, or fluid/electrolyte disorders.

Evidence Rating Level: Level 2 (Good)

Study Rundown: LRIs including bronchiolitis, influenza and community-acquired pneumonia (CAP), are widespread among pediatric patients, and are a significant cause of morbidity, mortality, and hospitalization. In recent years, care improvement initiatives have increasingly relied on hospital readmissions as a measure of care quality, with evidence from multiple studies showing many readmissions are potentially preventable. In this study, researchers analyzed data from pediatric inpatient Medicaid claims between 2008 and 2009 to better characterize unplanned readmissions within 30 days following initial hospitalization for LRI. Results showed that infants <1 year of age, boys, and patients with most chronic conditions had higher rates of readmission. Overall readmission rates varied widely among hospitals. LRIs, asthma, and fluid/electrolyte disorders were the leading diagnoses among children who were readmitted. This study is limited by its reliance on data from several years prior to publication, depicting results that may differ from current readmissions rates. This study is also limited in generalizability as it included data solely from Medicaid, potentially over representing a high-risk patient population. Results from this study provide direction for future improvement initiatives to prevent pediatric readmissions following LRIs.

Click to read the study, published today in Pediatrics

Relevant reading: Measuring pediatric hospital readmission rates to drive quality improvement

In-depth [retrospective cohort]: This study included Medicaid data from 150 590 pediatric inpatient visits for LRIs (index admissions) from 1929 hospitals in 26 states between 2008 and 2009. LRI admissions were defined as those for which a patient had a primary diagnosis of bronchiolitis, influenza, or CAP, or as visits with a secondary diagnosis of one of the 3 LRIs and a primary diagnosis of asthma, respiratory failure, or sepsis/bacteremia. Readmissions were included if they occurred <30 days since the index admission and were not planned (e.g. procedural admissions or scheduled chemotherapy). Researchers collected information on patient and hospital demographics, as well as reason for readmission. Results showed that 8233 of index admissions (5.5%) were associated with ≥1 readmission. Readmission rates varied from 3.8% to 8.8% between hospitals (p < .0001). The most frequent primary readmission diagnosis was LRI, followed by asthma and fluid/electrolyte disturbance (48.2%, 10.0%, and 3.4% respectively). Infants <1 year of age accounted for 47% of readmissions. Male children had higher odds of being readmitted (OR 1.11, p < .001), as did children with most chronic conditions, particularly neoplasms and disease of the nervous system and sense organs (OR 2.86 and 2.45, respectively, p <.001). Having a chronic infectious or parasitic disease, or certain chronic conditions originating in the perinatal period did not increase the odds of readmission (OR 1.49, p = .408; OR 1.38, p = .466, respectively).

Image: PD

©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.