Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia

Lilliam Ambroggio, Helena Herman, Emily Fain, Guixia Huang, Todd Adam Florin

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits.

METHODS: Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models.

RESULTS: Of the 3304 index ED visits by patients with CAP, 148 (4.5%) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95% confidence interval: 1.29-3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63% and 49%, respectively) to revisit the ED (95% confidence interval: 0.24-0.56 and 0.30-0.85, respectively).

CONCLUSIONS: Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.

Original languageEnglish (US)
Pages (from-to)718-723
Number of pages6
JournalHospital pediatrics
Volume8
Issue number11
DOIs
StatePublished - Nov 1 2018

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Hospital Emergency Service
Pneumonia
Logistic Models
Confidence Intervals
International Classification of Diseases
Treatment Failure
Disease Progression
Hospitalization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

Cite this

Ambroggio, Lilliam ; Herman, Helena ; Fain, Emily ; Huang, Guixia ; Florin, Todd Adam. / Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia. In: Hospital pediatrics. 2018 ; Vol. 8, No. 11. pp. 718-723.
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abstract = "BACKGROUND: Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits.METHODS: Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models.RESULTS: Of the 3304 index ED visits by patients with CAP, 148 (4.5{\%}) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95{\%} confidence interval: 1.29-3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63{\%} and 49{\%}, respectively) to revisit the ED (95{\%} confidence interval: 0.24-0.56 and 0.30-0.85, respectively).CONCLUSIONS: Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.",
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Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia. / Ambroggio, Lilliam; Herman, Helena; Fain, Emily; Huang, Guixia; Florin, Todd Adam.

In: Hospital pediatrics, Vol. 8, No. 11, 01.11.2018, p. 718-723.

Research output: Contribution to journalArticle

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T1 - Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia

AU - Ambroggio, Lilliam

AU - Herman, Helena

AU - Fain, Emily

AU - Huang, Guixia

AU - Florin, Todd Adam

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N2 - BACKGROUND: Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits.METHODS: Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models.RESULTS: Of the 3304 index ED visits by patients with CAP, 148 (4.5%) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95% confidence interval: 1.29-3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63% and 49%, respectively) to revisit the ED (95% confidence interval: 0.24-0.56 and 0.30-0.85, respectively).CONCLUSIONS: Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.

AB - BACKGROUND: Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits.METHODS: Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models.RESULTS: Of the 3304 index ED visits by patients with CAP, 148 (4.5%) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95% confidence interval: 1.29-3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63% and 49%, respectively) to revisit the ED (95% confidence interval: 0.24-0.56 and 0.30-0.85, respectively).CONCLUSIONS: Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.

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