What Are the Predictors of Length of Stay in Children Hospitalized With Asthma Exacerbation?
As the respiratory viral season enters into fill swing, children with underlying asthma are at an increased risk for exacerbation and hospitalization. Researchers from University of Texas Southwestern in Dallas examined a large cohort of hospitalized children with asthma exacerbation to assess for factors associated with length of stay (LOS) in this population.
This was a retrospective cohort study of patients aged 2 to 17 years discharged with a primary diagnosis of asthma in 2011. Using the Public Health Information System database of 42 contributing hospitals, demographic data, time of year of admission, and medical comorbidities were examined for association with hospital LOS. In total, 25 900 children with a discharge diagnosis of asthma were identified in the cohort. Multivariate logistic regression was used to examine the association between multiple variables and LOS, after adjusting for severity of illness.
The key findings
In 25 900 children included for analysis, the mean LOS was 1.9 days. Mean LOS was higher in children with chronic comorbid conditions (CCC) and in adolescents (P < .01). In addition, obstructive sleep apnea (odds ratio [OR] 2.3; 95% confidence interval [CI]: 1.8–2.9), older age (OR 1.3; 95% CI: 1.2–1.4), obesity (OR 1.3; 95% CI: 1.1–1.4), CCC (OR 1.3; 95% CI: 1.1–1.4), winter admissions (OR 1.2; 95% CI: 1.1–1.4), female gender (OR 1.1; 95% CI: 1.1–1.3), and weekend admissions (OR 1.1; 95% CI: 1.03–1.2) had higher odds of asthma LOS >2 days.
Why do we care?
The direct relevance of the data set reported here is clear to any hospitalist rounding on the wards during the high-volume winter months. Asthmatics with exacerbation during peak viral season have longer LOS than those admitted during nonwinter months. As hospitals struggle with capacity and throughput during the busy viral season, having targets at which to aim an intervention to decrease the LOS of our asthmatic patients may be vital in freeing up much-needed bed space. In this cohort, the LOS was already low at 1.9 days, making further relevant decrease difficult to achieve. However, having a starting place to target quality improvement measures and knowing on whom to center more intense asthma intervention and management may assist the busy hospitalist with the winter blues in opening up 1 more bed for 1 more bronchiolitic patient to come into the hospital.
CITATION Shanley LA, Lin H, Flores G. Factors associated with length of stay for pediatric asthma hospitalizations. J Asthma. 2015;52(5):471–477
Does Race and Socioeconomic Status Have an Impact on Abdominal Pain Evaluation in the Emergency Department?
The impact of race is well documented in health-disparities literature but rarely makes its way into hospitalist literature. A group of researchers from Stanford University examined the health outcomes of children presenting to the emergency department (ED) with abdominal pain to assess whether race or socioeconomic status affected patient outcome. The results have wide-reaching implications for hospitalists nationwide.
This was a retrospective study using the Public Health Information System database to examine pediatric patients discharged with a primary diagnosis of abdominal pain at the initial ED encounter. In total, 4.2 million encounters were assessed, representing 2.7 million pediatric patients evaluated between 2004 and 2011. Multivariate logistic regression was used to assess for association between independent variables (including race, household income, age, gender, payer type, geographic region, and comorbidities) and outcome variables (including ICU admission, appendicitis, perforated appendix, hospital admission, and imaging modalities).
The key findings
Of the variables assessed, black and low-income children had increased odds for perforated appendicitis (adjusted OR [aOR] 1.42 and aOR 1.20, respectively). Black children also had increased rates of ICU admission (aOR 1.92), longer LOS (adjusted hazard ratio 0.91), and lower rates of imagining for their appendicitis, including computed tomography scan. In addition, the combined effect of race and income status had a greater impact combined on rate of perforated appendicitis, hospitalization, and time to surgery than either variable independently.
Why do we care?
This study is the first and largest of its kind exploring health disparities in children evaluated in the ED with abdominal pain. The implications for pediatric hospital medicine are numerous, including the role of a pediatric hospitalist as an advocate for children nationwide. Our job is to ensure that every child everywhere has access to safe, quality pediatric care, regardless of race or socioeconomic status. We must strive diligently to overcome barriers that stand in our way, be they cultural, linguistic, local, or secular, and we must be champions in the fight to end health care disparity. Anything less is not deserving of our unique position in the delivery of pediatric healthcare in modern America.
CITATION Wang L, Haberland C, Thurm C, Bhattacharya J, Park KT. Health outcomes in US children with abdominal pain at major emergency departments associated with race and socioeconomic status. PLoS ONE. 2015;10(8):e0132758
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- Copyright © 2015 by the American Academy of Pediatrics