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Thavamani A, Velayuthan S, Patel D, Al-Hammadi N, Sferra TJ, Sankararaman S. Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome. Am J Gastroenterol 2023; 118:1439-1445. [PMID: 37052354 DOI: 10.14309/ajg.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sujithra Velayuthan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Patel N, Singh S, Desai R, Desai A, Nabeel M, Parikh N, Singh G, Patel S, Parikh R, Mahajan S. Thirty-day unplanned readmission in hospitalised asthma patients in the USA. Postgrad Med J 2021; 98:830-836. [PMID: 37063042 DOI: 10.1136/postgradmedj-2021-140735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Hospital quality improvement and hospital performance are commonly evaluated using parameters such as average length of stay (LOS), patient safety measures and rates of hospital readmission. Thirty-day readmission (30-DR) rates are widely used as a quality indicator and a quantifiable metric for hospitals since patients are often readmitted for the exacerbation of conditions from index admission. The quality of patient education and postdischarge care can influence readmission rates. We report the 30-DR rates of patients with asthma using a national dataset for the year 2013. OBJECTIVES The aim of our study was to assess the 30- day readmission (30-DR) rate as well as, the causes and predictors of readmissions. STUDY DESIGNS/METHODS Using the Nationwide Readmission Database (NRD) (2013), we identified primary discharge diagnoses of asthma by using International Classification of Diseases, Ninth Revision, Clinical Modification code '493'. Categorical and continuous variables were assessed by a χ2 test and a Student's t-test, respectively. The independent predictors of unplanned 30-DR were detected by multivariate analysis. We used sampling weights, which are provided in the NRD, to generate the national estimates. RESULTS There were 130 490 (weighted N=311 173) inpatient asthma admissions during 2013. The overall 30-DR for asthma was 11.9%. The associated factors for 30-DR were age 45-84 years (40.32% vs 29.05%; p<0.001), enrolment in Medicare (49.33% vs 30.61% p<0.001), extended LOS (mean, 4.40±0.06 vs 3.25±0.04 days; p<0.001), higher mean cost (US$8593.91 vs US$6741.31; p<0.001) and higher disposition against medical advice (DAMA) (4.14% vs 1.51%; p<0.001). The factors that increased the chance of 30-DR were advanced age (≥45-64 vs ≤17 years; OR 4.61, 95% CI 4.04 to 5.27, p<0.0001), male sex (OR 1.19, 95% CI 1.13 to 1.26, p<0.0001), a higher Charlson Comorbidity Index (CCI) (OR 1.16, 95% CI 1.14 to 1.18, p<0.0001), DAMA (OR 2.32, 95% CI 2.08 to 2.59, p<0.0001), non-compliance with medication (OR 1.34, 95% CI 1.24 to 1.46, p<0.0001), post-traumatic stress disorder (OR 1.48, 95% CI 1.22 to 1.79, p<0.0001), alcohol use (OR 1.45, 95% CI 1.27 to 1.65, p<0.0001), gastro-oesophageal reflux disease (OR 1.20, 95% CI 1.14 to 1.27, p<0.0001), obstructive sleep apnoea (OR 1.11, 95% CI 1.03 to 1.18, p<0.0042) and hypertension (OR 1.11, 95% CI 1.06 to 1.17, p<0.0001). CONCLUSIONS We found that the overall 30-DR rate for asthma was 11.9% all-cause readmission. Major causes of 30-DR were asthma exacerbation (36.74%), chronic obstructive pulmonary disease (11.47%), respiratory failure (6.46%), non-specific pneumonia (6.19%), septicaemia (3.61%) and congestive heart failure (3.32%). One-fourth of the revisits occurred in the first week, while half of the revisits took place in the first 2 weeks. Education regarding illness and the importance of medicine compliance could play a significant role in preventing asthma-related readmission.
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Affiliation(s)
- Neel Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sandeep Singh
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Aakash Desai
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Mohammed Nabeel
- Department of Critical Care Medicine, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Neil Parikh
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Gagandeep Singh
- Department of Medicine, Saint Francis Hospital, Tulsa, Oklahoma, USA
| | - Smit Patel
- Department of Internal Medicine, UCONN Health, Farmington, Connecticut, USA
| | - Radhika Parikh
- Department of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, Vermont, USA
| | - Supriya Mahajan
- Department of Allergy and Immunology, University at Buffalo, Buffalo, New York, USA
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Anbesse ZK, Mega TA, Tesfaye BT, Negera GZ. Early readmission and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory disease in Ethiopia: A prospective cohort study. PLoS One 2020; 15:e0239665. [PMID: 33022006 PMCID: PMC7537865 DOI: 10.1371/journal.pone.0239665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Significant numbers of chronic obstructive respiratory disease patients are readmitted for Acute Exacerbation (AE) within 30 days of discharge. And these early readmissions have serious clinical and socioeconomic consequences. The objective of our study was to determine the rate of readmission within 30 days of discharge and it’s predictors among patients treated for acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD). Methods A prospective cohort study involving 130 patients (asthma = 59, COPD = 71) was conducted from April-September, 2019, in Jimma Medical Center (JMC), South-West Ethiopia. Socio-demographic, clinical, laboratory, and drug-related data were recorded at admission and during hospital stay. Cox regression analysis was performed to identify risk factors for readmissions following an AE of asthma and COPD. Results During the study period, 130 (male, 78(60%)) patients were admitted with AE of asthma and COPD. The median age was 59(IQR, 50–70) years. Of 130 patients, 21(18.10%) had a new AE of asthma and COPD that required hospitalization in the 30 days after discharge. The overall median survival time to 30-day readmission was 20 days (IQR, 16–29). Multivariate analysis revealed prolonged use of oxygen therapy (AHR = 4.972, 95% CI [1.041–23.736] and frequent hospital admissions (AHR = 11.482 [1.308–100.793]) to be independent risk factors for early readmissions. Conclusion Early hospital readmission rates for AE of asthma and COPD were alarmingly high. Frequent hospital admission and long-term oxygen therapy during hospital stay were independent predictors of 30-day readmission.
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Affiliation(s)
- Zenebe Kano Anbesse
- Clinical Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshale Ayele Mega
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Getandale Zeleke Negera
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
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Sun W, Pan L, Zhang W. Risk factors for readmission of children hospitalized with acute asthma attacks in South China. J Asthma 2019; 58:438-447. [PMID: 31885292 DOI: 10.1080/02770903.2019.1705334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Asthma seriously endangers the health of children. Re-hospitalization for childhood asthma consumes a large amount of medical and health resources. The present study aimed to assess the rates and risk factors for hospital readmission of children with acute asthma attacks in south China. METHODS We retrospectively enrolled 1702 acute asthma patients aged < 18 years from 1/1/2007 to 12/31/2015. Patients who were readmitted within one year after index hospital discharge were divided into a readmission group. Index hospitalization data were acquired from clinical records. Chi-square tests and multivariate logistic regression analyses were used to evaluate the risk factors. RESULTS There were 90 (5.29%) readmitted patients from 1702 acute asthma patients. Considering the large sample differences between readmitted and single-admitted patients, 123 single-admitted patients (1.5-fold as many as the readmitted group) were randomly selected. Further univariate Chi-square tests and multivariate logistic regression analyses showed that the predictors of readmission included eczema history (odds ratio (OR) 3.122, p = 0.003) and mycoplasma pneumoniae (MP) antibody immunoglobulin M(IgM) (OR 2.386, p = 0.037). CONCLUSIONS Among the children admitted to a hospital in south China with acute asthma attacks, 5.29% were readmitted within the following year. Patients with history of eczema and positive MP antibody IgM had significantly increased the chances of one-year readmission, underlining the importance of targeted long-term postdischarge follow-up of these children.
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Affiliation(s)
- Wangming Sun
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lingzhi Pan
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,People's Hospital, Wenzhou, Zhejiang, China
| | - Weixi Zhang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Kang CM, Wu ET, Wang CC, Lu F, Chiang BL, Yen TA. Bilevel Positive Airway Pressure ventilation efficiently improves respiratory distress in initial hours treating children with severe asthma exacerbation. J Formos Med Assoc 2019; 119:1415-1421. [PMID: 31806384 DOI: 10.1016/j.jfma.2019.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Treatment of severe asthma exacerbation could be challenging, especially in the initial hours of acute attack when systemic corticosteroid is yet to take effect. In spite of using inhaled agents, the role of non-invasive ventilation (NIV), including Bilevel Positive Airway Pressure (BiPAP), had been addressed recently. METHODS We reviewed 5-year experience in our hospital for records of patients who were admitted to pediatric intensive care unit because of severe asthma attack. The included admission records from 2012 to 2017 were grouped according to BiPAP use (Yes/No). Clinical parameters (heart rate (HR), respiratory rate (RR), SpO2 and serum pCO2) at selected time intervals of treatment were collected for both groups and analyzed. RESULTS We included data of 46 admissions from 33 different patients (24 with BiPAP and 21 without BiPAP.) The BiPAP group had significantly higher initial RR as well as higher severity scores compared with the other group (p < 0.001). The RR improved significantly in the following time intervals in BiPAP group. There was no significant difference in HR between groups in any of the time intervals. The serum pCO2 levels decreased significantly after initiation of ventilation support in the BiPAP group, and SpO2 levels improved significantly for both groups. CONCLUSION BiPAP seemed efficient in improving respiratory rate and oxygenation in our study. It does not seem to cause additional irritation regarding that HR was not increased in BiPAP group compared with non-BiPAP group. Overall, BiPAP ventilation is safe and efficient in treating children with severe asthma attack.
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Affiliation(s)
- Chun-Min Kang
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Ting Wu
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Wang
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Frank Lu
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; The Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-An Yen
- The Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Jroundi I, Tse SM. Long-term asthma-related readmissions: comparison between children admitted and not admitted to the intensive care unit for critical asthma. J Asthma 2019; 58:10-18. [PMID: 31491362 DOI: 10.1080/02770903.2019.1663430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To compare the time to asthma-related readmission between children admitted to the intensive care unit (ICU) for asthma and those with a non-ICU hospitalization in the United States and to explore risk factors associated with readmission among children admitted in the ICU. METHODS In this retrospective cohort study, we included children aged 2-17 years in the State Inpatient Database (2005-2014) from four U.S. states who were hospitalized for asthma. We compared the time to asthma-related readmissions and emergency department (ED) visit between children admitted and not admitted to the ICU using the log-rank test. Among those admitted to the ICU, we explored factors associated with readmission using Cox regression. RESULTS 66 835 children were hospitalized for asthma, with 14.0% admitted to the ICU, and 12 844 were readmitted for asthma while 22 915 had an asthma-related ED visit. The time to asthma-related readmission was shorter in the ICU group compared to the non-ICU group (p < 0.001), but the time to asthma-related ED visit did not differ between the two groups (p = 0.43). Being preschool-aged, female, Black, and having lower household income and a longer length of stay during the initial hospitalization conferred a higher risk of asthma-related readmission among children admitted to the ICU. Preschool age and Medicaid were Florida-specific risk factors while Hispanic ethnicity was New York-specific. CONCLUSION Compared to children not admitted to the ICU, children admitted to the ICU for asthma were at increased risk of asthma-related readmission, with certain risk factors conferring an even higher risk.
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Affiliation(s)
- Imane Jroundi
- Department of Pediatrics, Unit of Training and Research in Public Health, School of Medicine and Pharmacy of Rabat, University of Mohamed V of Rabat, Rabat, Morocco
| | - Sze Man Tse
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, Montréal, Québec, Canada.,Université de Montréal, Montréal, Québec, Canada
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Lam HCY, Hajat S, Chan EYY, Goggins WB. Different sensitivities to ambient temperature between first- and re-admission childhood asthma cases in Hong Kong - A time series study. ENVIRONMENTAL RESEARCH 2019; 170:487-492. [PMID: 30641275 DOI: 10.1016/j.envres.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Asthma can be triggered by various factors due to different etiologies. Environmental factors remain a common trigger of asthma, especially amongst children, and such ambient exposures can be harder to avoid compared to behavioral triggers. As such, the contribution of environmental factors may be enhanced when considering repeat asthma cases compared to initial presentations. To test this hypothesis, we assessed associations between ambient temperature and hospital admissions for asthma in Hong Kong and stratified admission records into first and repeat asthma hospitalizations. METHODS The daily number of asthma hospitalizations among children aged 0-5 years in Hong Kong during 2007-2011 was regressed on daily mean temperature using distributed lagged nonlinear models, with adjustment for seasonal patterns, day-of-week effects, and other meteorological factors and air-pollutants. Analyses were stratified by summer/winter and by type of admission (first admission and repeated admission). RESULTS About 33% of the 12284 asthma hospitalizations were repeat admissions. Repeat admissions demonstrated higher sensitivity to high temperature in the summer. During this period, high temperatures were associated with increased risk of repeat admission but not with first admissions: RR (95% CI) comparing 31 °C vs. 29 °C across lags 0-15 days was 3.40 (1.26, 9.18) and 0.74 (0.31, 1.77) for repeat and first admissions respectively. In the cold season, all admissions increased with falls in temperature, with slightly stronger associations apparent for repeat admissions compared to first admission: 1.20 (1.00, 1.44) vs. 1.10 (0.96, 1.26) respectively comparing risk at 15 °C vs. 12 °C across lags 0-5 days. CONCLUSIONS To our knowledge, this is the first study to show stronger associations between ambient temperature and repeat asthma admissions compared to first admissions. The higher sensitivity among those experiencing repeat admissions may allow for more personalized disease management. Given the substantial differences in associations by admission type, future studies of ambient exposures on asthma should consider analyzing the two groups separately.
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Affiliation(s)
- Holly Ching Yu Lam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, University of London, United Kingdom
| | - Emily Ying Yang Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - William Bernard Goggins
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Zhou H, Roberts PA, Dhaliwal SS, Della PR. Risk factors associated with paediatric unplanned hospital readmissions: a systematic review. BMJ Open 2019; 9:e020554. [PMID: 30696664 PMCID: PMC6352831 DOI: 10.1136/bmjopen-2017-020554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs). DESIGN Systematic review. DATA SOURCE CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017. ELIGIBILITY CRITERIA Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included. DATA EXTRACTION AND SYNTHESIS Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form. RESULTS Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS. CONCLUSIONS This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Pam A Roberts
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | | - Phillip R Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Ruffner MA, Henrickson SE, Chilutti M, Grundmeier R, Spergel JM, Brown-Whitehorn TF. Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization. Ann Allergy Asthma Immunol 2018; 121:561-567. [PMID: 30170026 PMCID: PMC6236684 DOI: 10.1016/j.anai.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric asthma is a major contributor to emergency room utilization and hospital readmission rates. OBJECTIVE To develop an allergy department‒based intervention to improve follow-up appointment scheduling processes for pediatric asthma patients after discharge for asthma exacerbation. METHODS This quality improvement study was conducted in the allergy clinic of an urban, tertiary children's hospital. Children receiving subspecialty allergy care for asthma were included into the intervention group during the intervention period. The quality improvement intervention consisted of 3 attempts by telephone to reach the family to schedule the follow-up appointment. If this was unsuccessful or if the appointment was not kept, then a reminder letter was sent to the family. The primary outcome of interest in this study was the percent of postdischarge follow-up appointments scheduled within 30 days of discharge. Secondary outcomes measured were the percent of allergy appointments attended within 30 days of discharge and the 30-day hospital readmission rate. RESULTS Demographics did not differ significantly between the intervention and baseline preintervention year. The initial baseline scheduled allergy follow-up visit rate was 48.8 ± 13.3% of patients discharged per month. This increased to an overall rate of 75.7 ± 20.1% patients scheduling allergy follow-up within 30 days of discharge during the intervention year. We also observed a significant increase in attended allergy visits 30 days postdischarge from 35.5 ± 15.6% in year 1 to 53.9 ± 25.5% during the intervention year and a significant decrease in the 30-day readmission rate on the allergy service. CONCLUSION These data suggests that minor changes in allergy practice organization can significantly affect posthospitalization follow-up rates and decrease asthma readmission rates.
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Affiliation(s)
- Melanie A Ruffner
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Sarah E Henrickson
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marianne Chilutti
- Department of Biomedical Health and Informatics, The Children's Hospital of Philadelphia, Pennsylvania
| | - Robert Grundmeier
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical Health and Informatics, The Children's Hospital of Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terri F Brown-Whitehorn
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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Hennegrave F, Le Rouzic O, Fry S, Behal H, Chenivesse C, Wallaert B. Factors associated with daily life physical activity in patients with asthma. Health Sci Rep 2018; 1:e84. [PMID: 30623040 PMCID: PMC6266451 DOI: 10.1002/hsr2.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the consequences of asthma on daily life physical activity (DLPA). The aim of this study was to evaluate DLPA and determine its relationship to clinical and functional parameters in patients with asthma. METHODS This was a single-center prospective study of DLPA conducted between May 2015 and June 2016 in northern France. Fifty-one adult patients with asthma and 36 healthy control subjects were enrolled. Four DLPA parameters were assessed for 5 consecutive days with a physical activity monitor: number of steps walked per day (SPD), total energy expenditure (EE, in kcal/day), EE spent in physical activity requiring ≥3 metabolic equivalents (METs), and time (min) spent in activities requiring ≥3 METs. Clinical characteristics, pulmonary function tests, 6-minute walk test, and four questionnaires (modified Medical Research Council [mMRC] for dyspnea, asthma control test [ACT], quality of life [AQLQ], and hospital anxiety and depression scale [HADS]), were evaluated. Comparisons of DLPA parameters between the two groups were performed using an analysis of covariance adjusted for age, sex, and body mass index (BMI). Relationships between DLPA parameters and patient characteristics were assessed in multivariable linear regression models. RESULTS Compared with patients with mild/moderate asthma, those with severe asthma had lower mean (± standard deviation) forced expiratory volume in 1 s (FEV1) (66 ± 24 vs 94 ± 15% predicted, P < 0.001), ACT score (16.7 ± 4.5 vs 19.8 ± 4.2, P = 0.015), and AQLQ score (157 ± 40 vs 184 ± 33, P = 0.012). There were no significant differences between the two groups in SPD (6560 ± 3915 vs 8546 ± 3431; adjusted P = 0.95), EE in physical activity requiring ≥3 METs (620 ± 360 vs 660 ± 140 kcal/day; P = 0.86), time spent in activities requiring EE ≥3 (120 ± 54 vs 121 ± 32 min/day; P = 0.69), or total EE (2606 ± 570 vs 2666 ± 551 kcal/day; P = 0.80). These four DLPA measures showed strong inter-parameter correlations in patients with asthma (r = 0.37-0.95, all P < 0.01). All four parameters were lower in the patients with asthma group than in the control group: SPD, 7651 ± 3755 vs 11704 ± 4054 (adjusted P < 0.001); EE in activities requiring ≥3 METs, 642 ± 360 vs 852 ± 374 kcal/day (adjusted P = 0.041); time spent in activities requiring ≥3 EE, 120 ± 73 vs 189 ± 85 min (adjusted P = 0.005); and total EE, 2639 ± 555 vs 2746 ± 449 kcal/day (adjusted P = 0.007). In the patients with asthma group, the number of SPD correlated with age, FEV1, mMRC score, 6-minute walk test distance, and HADS scores, but not with BMI or ACT test score. Using multivariate analysis, the number of SPD was associated with only age, anxiety, and FEV1, whereas total EE was associated with mMRC score and BMI. CONCLUSION Age, anxiety, and FEV1 were significantly associated with the number of SPD in patients with asthma. Addressing anxiety should be further studied as way to attempt to increase physical activity in patients with asthma.
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Affiliation(s)
- Florence Hennegrave
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Olivier Le Rouzic
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Stéphanie Fry
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Hélène Behal
- Department of Biostatistics, Univ. Lille, EA 2694‐Santé Publique: Epidémiologie et Qualité des SoinsCHU LilleLilleFrance
| | - Cécile Chenivesse
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Benoit Wallaert
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
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11
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Kerkhof M, Tran TN, van den Berge M, Brusselle GG, Gopalan G, Jones RCM, Kocks JWH, Menzies-Gow A, Nuevo J, Pavord ID, Rastogi S, Price DB. Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study. PLoS One 2018; 13:e0201143. [PMID: 30044863 PMCID: PMC6059485 DOI: 10.1371/journal.pone.0201143] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background Recent studies have demonstrated an association between high blood eosinophil counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood eosinophil count documented before the first hospitalization. Methods This historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood eosinophil count within 1 baseline year before admission. We analyzed the association between high blood eosinophil count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection. Results We identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood eosinophil count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood eosinophil count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997). Conclusions A high blood eosinophil count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood eosinophil count require careful follow-up, with treatment optimization, after discharge.
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Affiliation(s)
- Marjan Kerkhof
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Trung N Tran
- AstraZeneca, Gaithersburg, MD, United States of America
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Gokul Gopalan
- AstraZeneca, Gaithersburg, MD, United States of America
| | - Rupert C M Jones
- The Peninsula College of Medicine and Dentistry, Plymouth, United Kingdom
| | - Janwillem W H Kocks
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Andrew Menzies-Gow
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - David B Price
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
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12
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Singh U, Wangia-Anderson V, Bernstein JA. Chronic Rhinitis Is a High-Risk Comorbidity for 30-Day Hospital Readmission of Patients with Asthma and Chronic Obstructive Pulmonary Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:279-285.e6. [PMID: 30053594 DOI: 10.1016/j.jaip.2018.06.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early hospital readmissions for asthma and chronic obstructive pulmonary disease (COPD), measured as hospital readmission within 30 days from the last discharge, is a major economic burden to our health care system. The association of this measure with comorbid chronic rhinitis (CR) has not been investigated before despite significant clinical association between CR and asthma or COPD. OBJECTIVE To investigate the association of CR with the risk of asthma or COPD-related early hospital readmission rates. METHODS This retrospective cohort study was performed using the asthma- and COPD-related hospital encounter and patient comorbidity data between June 15, 2012, and July 19, 2017, from a large hospital care system in Cincinnati, Ohio. Patients (any sex, race or socioeconomic status, and of all ages) with a primary discharge diagnosis of asthma (n = 4754 patients, 10,111 encounters) and COPD (n = 2176 patients, 4748 encounters) based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were included. Relevant comorbidities, including comorbid allergic rhinitis (AR) or nonallergic rhinitis (NAR), in such patients were identified using ICD-10-CM codes. The association between 30-day asthma or COPD-related hospital readmission (1670 such encounters for asthma and 736 for COPD) and comorbid CR in the affected patients were determined using Cox proportional hazards models. Multivariate-adjusted hazard ratios (HRs), adjusted for relevant patient comorbidities, compared 30-day asthma- and COPD-related readmissions of patients with CR with those patients without a CR diagnosis. RESULTS Analysis was performed on 4754 patients with asthma and 2176 patients with COPD. The median follow-up period (+interquartile range) for asthma was 980 (+760) days and for COPD was 553 (+827) days. The HRs for 30-day asthma- or COPD-related readmission rates were significantly higher in patients with AR (HR = 4.4 [3.9, 5.0] and 2.4 [1.7, 3.2], respectively) or NAR (HR = 3.7 [2.9, 4.9] and 2.6 [1.8, 3.7], respectively) compared with patients without rhinitis. For asthma, both AR and NAR had higher HRs compared with all other comorbidities analyzed. For COPD, both AR and NAR had HRs to the magnitude as obesity and hypertension. CONCLUSIONS Comorbid CR is significantly associated with 30-day asthma- and COPD-related readmissions. These findings are useful for guiding health care professionals to focus on outpatient management of both the upper and lower respiratory tracts to reduce early readmission of patients with asthma and COPD.
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Affiliation(s)
- Umesh Singh
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Victoria Wangia-Anderson
- Clin & Health Info Sci, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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13
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Gonzalez-Barcala FJ, San-Jose ME, Nieto-Fontarigo JJ, Carreira JM, Calvo-Alvarez U, Cruz MJ, Facal D, Garcia-Sanz MT, Valdes-Cuadrado L, Salgado FJ. Association between blood eosinophil count with asthma hospital readmissions. Eur J Intern Med 2018. [PMID: 29514744 DOI: 10.1016/j.ejim.2018.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The presence of eosinophils in asthma inflammation is a relevant factor in the pathophysiology of the disease, however the relationship between the blood eosinophil count (BEC) with asthma severity and prognosis is still under debate. The aim of this work is to analyze the relationship between the BEC levels and hospital readmissions in patients with asthma. MATERIAL AND METHODS A review was retrospectively carried out on all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. The personal characteristics and the asthma personal history of each patient were recorded. The BEC was determined from the first blood sample taken from the patient after their arrival at the hospital. Hospital early, late and frequent readmissions were analyzed using 4 cut-off points; less than 150 eosinophils/μL vs ≥150/μL, less than 200 vs 200 /μL, less than 300 vs ≥300/μL, and less than 400 vs ≥400/μL. RESULTS We have included 1316 patients, 70% of whom are women, as well as a mean age of 60 years, and a mean FEV1 of 73.5% of the reference value. The mean eosinophil blood count was 201.7 cells/μL. A BEC ≥300 cells/μL showed a reduction of risk of late readmission of 42%, a BEC ≥400 cells/μL showed a reduction in late readmission risk of 41% and decrease in frequent late readmission of 63%. CONCLUSIONS Our study appears to support that an elevated BEC is associated with a lower incidence of asthma hospital readmissions.
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Affiliation(s)
- Francisco-Javier Gonzalez-Barcala
- Department of Medicine-University of Santiago de Compostela, Spain; Spanish Biomedical Research Networking Centre-CIBERES, Spain; Department of Respiratory Medicine-University Hospital of Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Spain.
| | - Maria-Esther San-Jose
- Clinical Analysis Service, University Hospital of Santiago de Compostela (CHUS), Spain
| | - Juan-José Nieto-Fontarigo
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), Universidade de Santiago de Compostela, Spain
| | | | - Uxio Calvo-Alvarez
- Department of Respiratory Medicine-University Hospital of El Ferrol, Spain
| | - Maria-Jesus Cruz
- Spanish Biomedical Research Networking Centre-CIBERES, Spain; Department of Respiratory Medicine-Hospital Vall d'Hebron, Spain
| | - David Facal
- Spanish Biomedical Research Networking Centre-CIBERES, Spain; Department of Developmental Psychology, University of Santiago de Compostela, Spain
| | | | - Luis Valdes-Cuadrado
- Department of Medicine-University of Santiago de Compostela, Spain; Department of Respiratory Medicine-University Hospital of Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Francisco-Javier Salgado
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), Universidade de Santiago de Compostela, Spain
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14
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The Role of Mental Health Disease in Potentially Preventable Hospitalizations: Findings From a Large State. Med Care 2017; 56:31-38. [PMID: 29189574 DOI: 10.1097/mlr.0000000000000845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors. OBJECTIVE The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality. DESIGN/SUBJECTS The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008. MEASURES A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date. RESULTS A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22-1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12-1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66-3.72 for age above 75 years compared with 18-44 y), black race (OR 1.44; 95% CI, 1.43-1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51-1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22-1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17-1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations. CONCLUSIONS Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.
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15
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Abstract
OBJECTIVES To compare the time to asthma-related readmissions between children with a previous ICU hospitalization for asthma and those with a non-ICU hospitalization and to explore predictors of time to readmission in children admitted to the ICU. DESIGN Retrospective cohort study using a pan-Canadian administrative inpatient database from April 1, 2008, to March 31, 2014. SETTING All adult and pediatric Canadian hospitals. SUBJECTS Children 2-17 years old with a hospitalization for asthma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 26,168 children were hospitalized 33,304 times during the study period. The time to readmission was shorter in the ICU group compared with the non-ICU group (median time to readmission 27 mo in ICU vs 35 mo in non-ICU group). Preschool-aged children (hazard ratio, 1.48; 95% CI, 1.02-2.14) and increased length of stay (hazard ratio, 1.63; 95% CI, 1.17-2.27) were associated with a shorter time to readmission. CONCLUSIONS Children previously admitted to the ICU for asthma had a shorter time to asthma-related readmission, compared with children who did not require intensive care, underlining the importance of targeted long-term postdischarge follow-up of these children. Children of preschool age and who have a lengthier hospital stay are particularly at risk for future morbidity.
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16
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Okubo Y, Michihata N, Yoshida K, Morisaki N, Matsui H, Fushimi K, Yasunaga H. Impact of pediatric obesity on acute asthma exacerbation in Japan. Pediatr Allergy Immunol 2017; 28:763-767. [PMID: 29044803 DOI: 10.1111/pai.12801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Asthma and obesity are common health problems in children. This study investigated the impact of obesity on children hospitalized with acute asthma exacerbation. METHODS We obtained the hospital discharge records of inpatients aged 3-8 years with a diagnosis of asthma using a national inpatient database in Japan. The patients were classified into underweight, normal weight, overweight, and obese groups using weight for height and body mass index for age provided by the World Health Organization. We compared 30-day re-admission, need for intensive care, mean total hospitalization costs, and length of hospital stay between the 4 groups using multivariable regression models. RESULTS Overall, 38 679 patients were identified, including 3177 underweight, 28 904 normal weight, 3334 overweight, and 3264 obese patients. The obese group showed significantly higher 30-day re-admission (adjusted odds ratio, 1.26; 95% confidence interval, 1.03-1.54) and longer length of stay (adjusted difference, 0.12 days; 95% confidence interval, 0.10-0.20 days) than the normal weight group. The threshold was a 91st percentile of weight for length or body mass index for the relationship with 30-day re-admission. No significant difference was observed between the 4 groups regarding the need for intensive care and total hospitalization costs. CONCLUSION These findings demonstrated that obesity was a risk factor for repeated admissions caused by asthma in children, indicating the importance for the prevention of pediatric obesity.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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17
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Gonzalez-Barcala FJ, Calvo-Alvarez U, Garcia-Sanz MT, Garcia-Couceiro N, Martin-Lancharro P, Pose A, Carreira JM, Moure-Gonzalez JD, Valdes-Cuadrado L, Muñoz X. Asthma exacerbations: risk factors for hospital readmissions. Ir J Med Sci 2017; 187:155-161. [PMID: 28593573 DOI: 10.1007/s11845-017-1633-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.
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Affiliation(s)
- F-J Gonzalez-Barcala
- Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain. .,Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain. .,CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain.
| | | | | | - N Garcia-Couceiro
- Servicio de Neumología-Hospital Clinico, Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - P Martin-Lancharro
- Servicio de Salud Laboral-Hospital Clinico, Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Pose
- Servicio de Medicina Interna-Hospital Clinico, Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J-M Carreira
- Departamento de Radiología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - J-D Moure-Gonzalez
- Servicio de Pediatria-Hospital Clinico, Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - L Valdes-Cuadrado
- Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - X Muñoz
- CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain.,Servicio de Neumología-Hospital, Universitario Vall d'Hebron-Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
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