scholarly journals Thirty-day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

2011 ◽  
Vol 58 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Amy Sobota ◽  
Dionne A. Graham ◽  
Ellis J. Neufeld ◽  
Matthew M. Heeney
Keyword(s):  
Risk Factors ◽  
Sickle Cell ◽  
Readmission Rates ◽  
Children's Hospitals ◽  
Hospital Variation ◽  
Children’S Hospitals ◽  
Sickle Cell Crisis

A MULTI-INSTITUTIONAL, 5-YEAR ANALYSIS OF INITIAL AND MULTIPLE VENTRICULAR SHUNT REVISIONS IN CHILDREN

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 445-454 ◽  
Author(s):  
Jay G. Berry ◽  
Matthew A. Hall ◽  
Vidya Sharma ◽  
Liliana Goumnerova ◽  
Anthony D. Slonim ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Hospital Volume ◽  
Revision Rate ◽  
Shunt Revision ◽  
Children's Hospitals ◽  
Shunt Placement ◽  
Hospital Variation ◽  
Children’S Hospitals ◽  
Year 2000

Abstract OBJECTIVE To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children. METHODS A retrospective, longitudinal cohort of 1307 children ages 0 to 18 years undergoing initial ventricular shunt placement in the year 2000, with follow-up through 2005, from 32 freestanding children's hospitals within the Pediatric Health Information Systems database was studied. Rates of ventricular shunt revision were compared with patient demographic, clinical, and hospital characteristics with use of bivariate and multivariate regression accounting for hospital clustering. RESULTS Thirty-seven percent of children required at least one shunt revision within 5 years of initial shunt placement; 20% of children required two or more revisions. Institutional rates of first shunt revision ranged from 20 to 70% of initial shunts placed among the 32 hospitals in the cohort. Hospitals where one to 20 initial shunt placements per year experienced the highest initial shunt revision rate (42%). Hospitals performing over 83 initial shunt placements per year experienced the lowest revision rate (22%). We found that children undergoing shunt placement in the Midwest were more likely to experience multiple shunt revisions (odds ratio, 1.25; 95% confidence interval, 1.06–1.47) after controlling for hospital volume, shunt type, age, and diagnosis associated with initial shunt placement. CONCLUSION Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.

Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births

2014 ◽  
Vol 42 (4) ◽  
Author(s):  
Nada Alayed ◽  
Abbas Kezouh ◽  
Lisa Oddy ◽  
Haim A. Abenhaim
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
Pregnant Women ◽  
Sickle Cell ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Morbidity And Mortality ◽  
Cell Disease ◽  
Sickle Cell Crisis ◽  
Hemoglobin Variants

AbstractTo estimate the prevalence of sickle cell disease (SCD) in pregnancy, and to measure risk factors, morbidity, and mortality among women with SCD with and without crisis at the time of birth.We conducted a population-based, retrospective cohort study on all births in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2008. Births to SCD with and without crisis were identified using ICD-9 codes. Adjusted effects of risk factors and outcomes were estimated using logistic regression analyses. Effect of hemoglobin variants among women with SCD was analyzed as a predictor of crisis.There were 4262 births to women with SCD for an overall prevalence of 4.83 per 10,000 deliveries. 28.5% of women with SCD developed crisis at the time of delivery. The maternal mortality rate was 1.6 per 1000 deliveries in women with SCD, compared to 0.1 per 1000 in women without SCD. Pregnant women with SCD had a higher risk of developing preeclampsia, eclampsia, venous thromboembolism, cardiomyopathy, intrauterine fetal demise, and intrauterine growth restriction. Cesarean delivery rates were higher in women with SCD. Among the 1898 SCD women with identified hemoglobin variants, homozygous SS was the greatest risk factor for sickle cell crisis, accounting for 89.8% of all women who developed crisis.Pregnant women with SCD have a high risk of morbidity and mortality. Developing acute sickle cell crisis worsened perinatal outcomes.

Children's Hospitals with Shorter Lengths of Stay Do Not Have Higher Readmission Rates

2013 ◽  
Vol 163 (4) ◽  
pp. 1034-1038.e1 ◽  
Author(s):  
Rustin B. Morse ◽  
Matthew Hall ◽  
Evan S. Fieldston ◽  
Denise M. Goodman ◽  
Jay G. Berry ◽  
...  
Keyword(s):  
Readmission Rates ◽  
Children's Hospitals ◽  
Lengths Of Stay ◽  
Children’S Hospitals

Induction Mortality In Pediatric Acute Lymphoblastic Leukemia (ALL): a Retrospective Cohort Analysis From the Pediatric Health Systems Information (PHIS) Database, 1999–2009

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3239-3239
Author(s):  
Alix E. Seif ◽  
Susan R. Rheingold ◽  
Brian T. Fisher ◽  
Yuan-Shung V. Huang ◽  
Yimei Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Induction Chemotherapy ◽  
Demographic Characteristics ◽  
Age At Diagnosis ◽  
Newly Diagnosed ◽  
Children's Hospitals ◽  
Hispanic Ethnicity ◽  
Children’S Hospitals ◽  
Pediatric All

Abstract Abstract 3239 We sought to define factors identifying children at increased risk for mortality during the induction phase of chemotherapy for ALL. We identified a cohort of 11,145 pediatric patients with newly diagnosed ALL using PHIS data from 1999–2009. The PHIS database contains de-identified records of all admissions from 42 children's hospitals across the United States, representing 85% of pediatric admissions to freestanding children's hospitals. Data are internally validated by PHIS, and participating hospitals must have an error rate of <2%. Patients were further validated by manual comparison of induction chemotherapy to published ALL induction standards. Information included in the database are patient demographics, ICD-9 codes, and resource utilization codes for pharmacy, radiology and other procedures. Our strategy to identify newly diagnosed ALL patients included all patients from birth to age 18.99 years with an ICD-9 code for ALL (204.xx) who received one of a series of 3- or 4-drug induction chemotherapy regimens based on standard practices for the era studied. Data were analyzed from the first 30 days after initial admission for ALL. Table 1 shows demographic characteristics, as well as clinical characteristics hypothesized to predict increased mortality. There were 172 patients who died during the study period (1.54%; Table 2). Age <1 year was associated with markedly increased mortality compared to ages 1–9.99 years; patients ages 10–18.99 also had increased mortality. Sex, race and Hispanic ethnicity were not predictive of mortality. We hypothesized that Down syndrome, anthracycline exposure and dexamethasone exposure would be risk factors; however, none of these exposures significantly predicted increased mortality compared to patients without these exposures. Certain interventions were strong predictors of mortality, such as intubation, use of pressors, intubation with concomitant pressors, extracorporeal membrane oxygenation (ECMO), and hemodialysis (Table 2). We tabulated the frequency of ICD-9 codes during the admission in which mortality was observed. The most commonly associated diagnoses were: respiratory failure, acidosis, aplastic anemia, pleural effusion, hemorrhagic stroke, renal failure, sepsis, coagulopathy, complications of a vascular device, hyponatremia, hypotension/shock, pneumonia, and seizure. We are in the process of further analyzing these diagnostic codes for prediction of mortality risk. In summary, we present the largest published dataset of induction mortality in pediatric ALL. Additionally, this is the first use of a nationally representative pediatric ALL dataset that includes patients irrespective of clinical trial enrollment. We are currently performing multivariate analyses using ICD-9 discharge, procedure and utilization codes to define risk factors for induction mortality. Using these analyses, we will develop a model that may allow practitioners to intervene against poor outcomes in high-risk patients. Finally, these data can provide national benchmarks for ALL induction mortality and complication rates that will be critically important in this era of increasing emphasis on patient safety. Table 1: Demographic characteristics of PHIS ALL cohort, 1999–2009 Patient characteristic N (%) Age at diagnosis, median 5.7 years     <1 year 410 (3.68)     1-9.99 years 7543 (67.68)     10-18.99 years 3192 (28.64) Female 4835 (43.38) Race     Caucasian 8430 (75.66)     African American 938 (8.42)     Asian/Pacific Islander 327 (2.93)     Native American 78 (0.70)     Other/unknown 808 (7.25)     Missing 562 (5.04) Hispanic ethnicity 2376 (21.32) Down syndrome 304 (2.73) Anthracycline exposure 4645 (41.68) Dexamethasone exposure 5393 (48.39) Hospitalization data Mean ± SD Median (range) Duration of 1st admission 13.31 ± 14.82 9 (1-283) Number of hospitalizations in 1st 30 days 1.35 ± 0.59 1 (1-5) Table 2: Risk of mortality by demographics and need for intervention Risk factor Mortality rate, N (%) RR (95% CI) Overall 172 (1.54) – Age at diagnosis     <1 year 23 (5.61) 7.17 (4.48, 11.49)     1-9.99 years 59 (0.78) 1.0     10-18.99 years 90 (2.82) 3.61 (2.60, 4.99) Any Intubation     Yes 99 (26.68) 39.38 (29.64, 52.32)     No 73 (0.68) 1.0 Pressors     Yes 74 (16.34) 17.82 (13.38, 23.74)     No 98 (0.92) 1.0 Any Intubation + pressors     Yes 60 (45.11) 44.36 (34.10, 57.69)     No 112 (1.02) 1.0 ECMO     Yes 6 (75.00) 50.32 (32.81, 77.17)     No 166 (1.49) 1.0 Hemodialysis     Yes 29 (15.59) 11.95 (8.24, 17.33)     No 143 (1.30) 1.0 Disclosures: No relevant conflicts of interest to declare.

scholarly journals 2334. Risk Factors of Multidrug-Resistant Gram-Negative Bacterial Bloodstream Infections in Children’s Hospitals in Japan

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S693-S694
Author(s):  
Yuta Aizawa ◽  
Takayo Shoji ◽  
Kenta Ito ◽  
Masashi Kasai ◽  
Hiroki Sakurai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Children's Hospitals ◽  
Gram Negative ◽  
Children’S Hospitals

Neonatal Abstinence Syndrome among Infants Born to Mothers with Sickle Cell Hemoglobinopathies

2019 ◽  
Vol 37 (03) ◽  
pp. 326-332 ◽  
Author(s):  
Jewel A. Brown ◽  
Rachel G. Sinkey ◽  
Thora S. Steffensen ◽  
Adetola F. Louis-Jacques ◽  
Judette M. Louis
Keyword(s):  
Risk Factors ◽  
Sickle Cell ◽  
Pain Control ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Cell Disease ◽  
Opioid Dose ◽  
Sickle Cell Crisis

Abstract Objective The objective of this study is to examine risk factors for neonatal abstinence syndrome (NAS) among infants born to mothers with sickle cell hemoglobinopathies (SCH). Study Design Retrospective cohort study of nonanomalous, singleton infants born to mothers with laboratory confirmed SCH. Infants were included if they were diagnosed with NAS prior to hospital discharge. The outcome of interest was the association of maternal variables with NAS. Results Of 131 infants born to mothers with SCH, 4% (n = 5) were diagnosed with NAS. Mothers of infants with NAS were more likely to have SC disease (80%) compared with other SCH (20%), p = 0.001. Fifteen women had antepartum (AP) admissions for pain and/or sickle crisis. Of these patients, four infants (29%) were diagnosed with NAS. The median (5th and 95th percentile) maternal AP length of stay for women with infants diagnosed with NAS to mothers with sickle cell disease was 132 (5, 180) days (p = 0.02). Conclusion Incidence of NAS among mothers with SCH is low; severe disease characterized by AP sickle cell crisis requiring prolonged AP admission for pain control significantly increases the risk of NAS. Further studies are needed to investigate the association of maternal opioid dose and NAS.

scholarly journals Risk Factors for Venous Thrombo-Embolism in Children with Sickle Cell Disease: a Multicenter Cohort Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 7-7 ◽  
Author(s):  
Riten Kumar ◽  
Joseph R Stanek ◽  
Susan E Creary ◽  
Sarah O'Brien
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Sickle Cell Disease ◽  
Renal Disease ◽  
Sickle Cell ◽  
Chronic Renal Disease ◽  
Cell Disease ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Children’S Hospitals

Abstract Background: A hypercoagulable state resulting in increased venous thrombo-embolism (VTE) has been described in adults with sickle cell disease (SCD). Similar data for children is lacking. Previously, in a single-institution, retrospective study of 414 pediatric patients with SCD followed at Nationwide Children's Hospital (NCH) between 2009 and 2015, we identified central venous catheters (CVC) as an independent risk factor for VTE [OR (± 95%CI): 10.3 (1.1-92.2)]. 12/414 (2.9%) subjects developed VTE over the course of the study1. The objective of this retrospective, multicenter cohort study was to describe risk factors associated with VTE in children with SCD across children's hospitals in the United States (US). Methods: This study was deemed to be exempt by the Institutional Review Board at NCH. Data source for this multicenter cohort study was the Pediatric Health Information Systems (PHIS), an administrative database that contains clinical and resource utilization data for inpatient, ambulatory surgery, emergency department and observation unit patient encounters for 49 free standing children's hospitals in the US. Data quality and reliability are assured through a joint effort between Children's Hospital Association and participating institutions2. ICD-9-CM codes were used to identify subjects. Eligible subjects were <21 years of age, were admitted to one of the PHIS hospitals between 01/01/2009 and 12/31/2013 and had at least 2 SCD specific ICD-9 discharge codes. VTE and comorbid conditions of interest (congenital heart disease, cancer, chronic renal disease, obesity, inflammatory bowel disease etc) were also identified using ICD-9 codes. Supply codes were used to identify CVC placement and pharmaceutical billing codes to identify oral contraceptive use. Logistic regression analysis was used to study association between unique patient characteristics and VTE. Due to the low event rate of VTE, logistic regression models were corrected using the Firth method. Variables found to be significant (p-value < 0.05) on univariate analysis were entered into a multivariable model. All data were summarized and presented using descriptive statistics. All statistical analyses were performed using SAS software, version 9.3 (SAS Institute, Cary, NC). Results: A total of 8941 unique subjects (4359 female) met inclusion criteria with a mean age (± 95%CI) of 7.28 (7.14-7.42) years. 159 subjects (96 female) developed VTE during the study period. Mean age (± 95%CI) at VTE diagnosis was 14.73 (13.84-15.63) years. No increase in VTE diagnosis was appreciated over the course of the study. On multivariable analysis, any CVC placement [OR (± 95%CI): 8.9 (6.45-12.3); p<0.0001], chronic renal disease [5.19 (1.48-18.19); p=0.01], female gender [1.59 (1.15-2.20); p=0.005), and older age at admission [1.10 (1.07-1.12); p<0.0001] were identified as risk factors associated with VTE diagnosis. Patients with SCD and VTE were more likely to be admitted to the intensive care unit (1.61 (0.99-2.62); p=0.05), though VTE diagnosis had no impact on mortality [1.49 (0.44-5.10); p=0.5]. Conclusion: Rate of VTE in children with SCD admitted to children's hospitals in the US is around 1.8%. CVC use is associated with a nearly 9-fold increased risk of VTE diagnosis. Additionally, chronic renal disease, female gender and older age at admission were also associated with VTE diagnosis. Prospective cohort studies are needed to confirm these findings and develop risk prediction models for VTE in children with SCD. Such studies will help develop and validate evidence based VTE prophylactic regimens for children with SCD. Reference: 1. Woods G, Sharma R, Creary S, et al. Venous thrombo-embolism (VTE) in children with sickle cell disease (SCD): an institutional experience. Journal of Thrombosis and Haemostasis. 2015;13:58-58. 2. Witmer CM, Lambert MP, O'Brien SH, Neunert C. Multicenter Cohort Study Comparing U.S. Management of Inpatient Pediatric Immune Thrombocytopenia to Current Treatment Guidelines. Pediatr Blood Cancer. 2016;63(7):1227-1231. Disclosures No relevant conflicts of interest to declare.

Hospitalization Trend for Children and Adolescents with Sickle Cell Disease in the USA: A Pediatric Health Information Database Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 479-479
Author(s):  
Ram Kalpatthi ◽  
Brian R. Lee ◽  
Jignesh Dalal
Keyword(s):  
Sickle Cell Disease ◽  
Health Information ◽  
Sickle Cell ◽  
Clinical Care ◽  
Cell Disease ◽  
Children's Hospitals ◽  
Discharge Data ◽  
Pediatric Health ◽  
Children’S Hospitals ◽  
The Usa

Abstract Abstract 479 Introduction: Over the past several decades, survival of young children with sickle cell disease (SCD) has improved dramatically with innovations in basic science and clinical care Historically, interventions such as newborn screening, prophylactic penicillin, and immunization against invasive bacteria played a significant role in decreasing childhood mortality Other advances in preventive care such as hydroxyurea therapy and comprehensive care have been increasingly postulated as the next line of innovations to improve outcomes for children with SCD, particularly with respect to VOC. There is scanty literature about the pattern of hospitalization for children with SCD in US. As hospitalization consumes lots of economic resources, we studied the trend of hospitalization of children with sickle cell disease over the last decade. Methods: We used the Pediatric Health Information System (PHIS), a database of clinical and financial data from free-standing children's hospitals in the US. Only patients under the age of 21 who were hospitalized at one of the 35 PHIS hospitals that provided discharge data from 2000–2011 were included in the analysis. We examined patient demographics, timing of hospitalizations, complications, and prescription medication for these patients. The PHIS database provides an encrypted patient medical record number, thus we were able to follow patients over time. This allowed for a better visualization of the patient's hospitalizations, complications, and medications over 11 years. Results: From 2000 to 2011, there were 1635 unique pediatric patients with SCD accounting for 9222 hospitalizations in 35 children's hospitals in the USA. Overall, the number of new patients with SCD getting hospitalized has decreased consistently every year during the study period (Figure 1A). Specifically, there was a dramatic decrease in the number of new patients getting hospitalized in the southern USA compared to other regions. There was a sharp decline in the overall number of hospitalizations from the year 2003 to 2004 (1200 vs. 500 hospitalizations respectively). However, the hospitalization rate after 2004 remained similar till the year 2011. There was no difference between males and females in the hospitalizations rate. SCD patients aged 13–21 years accounted for higher number of hospitalizations where as patients aged 6–12 years accounted for the lower number of hospitalizations (Figure 1B). Patients with Hb-SS phenotype accounted for majority of the hospitalizations (Figure 1C). Vasoocclusive crises (VOC) remained the most common reason for hospitalization. There was only one hospitalization for pneumococcal sepsis (Table 1). There was only 250 patients (15%) were found to have receiving hydroxyurea. Conclusions: Our data show a decreasing trend of hospitalizations for new SCD patients in the USA suggesting an overall improvement of comprehensive health care for these patients. This is consistent with the report by Day et al from the United Kingdom. Despite MSH and Baby HUG study trials demonstrating the efficacy of hydroxyurea, it was significantly underutilized, as VOC remains the major indication of hospitalization. Studies addressing the barriers of hydroxyurea use, clinical trials of Vitamin D or glutamine supplementation are needed to prevent or decrease this major health burden (VOC) in this population. Disclosures: No relevant conflicts of interest to declare.

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