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Pediatr Pulmonol. 2018 Mar;53(3):349-357. doi: 10.1002/ppul.23938. Epub 2018 Jan 4.

Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy.

Author information

1
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
2
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
3
Children's Hospital Association, Lenexa, Kansas.
4
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington.
5
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
6
Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California.
7
Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
8
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

Abstract

OBJECTIVE:

Identify characteristics associated with hospital readmission due to bacterial respiratory tract infections (bRTI) after tracheotomy.

STUDY DESIGN:

Retrospective study of 8009 children 0-17 years undergoing tracheotomy from 2007 to 2013 at 48 children's hospitals in the Pediatric Health Information System database. The primary outcome was first hospital admission after tracheotomy for bRTI (ie, primary diagnosis of bRTI or a primary diagnosis of bRTI symptom and secondary diagnosis of bRTI). We used Cox-proportional hazard modeling to assess associations between patient demographic and clinical characteristics and bRTI hospital readmission.

RESULTS:

Median age at tracheotomy admission was 5 months (interquartile range [IQR]: 1-50 months). Thirty-six percent (n = 2899) had at least one bRTI admission. Median time-to-readmission for bRTI was 275 days (IQR: 141-530). Factors independently associated with increased risk for bRTI readmission were younger age (eg, age < 30 days vs 13-17 years [aHR 1.32; 95%CI: 1.11-1.58]), Hispanic race/ethnicity (vs non-Hispanic White; aHR: 1.34; 95%CI: 1.20-1.50), government insurance (vs private; aHR 1.21; 95%CI: 1.10-1.33), >2 complex chronic conditions (vs zero; aHR 1.96; 95%CI: 1.34-2.86) and discharge to home (vs post-acute care setting; aHR 1.19; 95%CI: 1.08-1.32). Trauma diagnosis at tracheotomy (aHR 0.83; 95%CI: 0.69-1) and ventilator dependency (aHR 0.88; 95%CI: 0.81-0.97) were associated with decreased risk.

CONCLUSIONS:

Young, Hispanic children with multiple complex chronic conditions who use Medicaid insurance and are not discharged to post-acute care are at the highest risk for hospital readmission for bRTI post-tracheotomy. Future research should investigate strategies to mitigate this risk for these children.

KEYWORDS:

children with medical complexity; readmissions; tracheotomy

PMID:
29314789
PMCID:
PMC5815950
DOI:
10.1002/ppul.23938
[Indexed for MEDLINE]
Free PMC Article

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