TY - JOUR
T1 - Mortality During Readmission Among Children in United States Children's Hospitals
AU - Rees, Chris A.
AU - Neuman, Mark I.
AU - Monuteaux, Michael C.
AU - Michelson, Kenneth A.
AU - Duggan, Christopher P.
N1 - Funding Information:
Supported by the National Institutes of Health (Grants K24 DK104676 and 2P30 DK040561 , to C.D.) and the Agency for Healthcare Research and Quality (Grant K08 HS026503 , to K.M.). C.D. serves on the Editorial Board of The Journal of Pediatrics. The funders had no role in the study design, the collection, analysis, or interpretation of the data, the writing of the report, or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/7
Y1 - 2022/7
N2 - Objective: To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization. Study design: We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010 to June 2020. Our primary outcome was death during readmission within 180 days of an index hospitalization among children aged 0-18 years. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group–categorized illness severity (ie, minor, moderate, or major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission. Results: Among 2 677 111 children discharged, 337 385 (12.6%) were readmitted within 180 days of the index hospitalization and 2913 (0.8%) died during readmission. More than one-quarter (26.2%) of deaths among children who were readmitted and died occurred within 10 days after discharge from the index hospitalization. Factors independently associated with mortality during readmission included multiple complex chronic conditions, index admissions lasting >7 days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission compared with children of other races. Conclusions: Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.
AB - Objective: To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization. Study design: We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010 to June 2020. Our primary outcome was death during readmission within 180 days of an index hospitalization among children aged 0-18 years. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group–categorized illness severity (ie, minor, moderate, or major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission. Results: Among 2 677 111 children discharged, 337 385 (12.6%) were readmitted within 180 days of the index hospitalization and 2913 (0.8%) died during readmission. More than one-quarter (26.2%) of deaths among children who were readmitted and died occurred within 10 days after discharge from the index hospitalization. Factors independently associated with mortality during readmission included multiple complex chronic conditions, index admissions lasting >7 days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission compared with children of other races. Conclusions: Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.
KW - United States
KW - children's hospitals
KW - complex chronic conditions
KW - disparities
KW - mortality
KW - pediatric
KW - readmissions
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U2 - 10.1016/j.jpeds.2022.03.040
DO - 10.1016/j.jpeds.2022.03.040
M3 - Article
C2 - 35364094
AN - SCOPUS:85128648826
SN - 0022-3476
VL - 246
SP - 161-169.e7
JO - journal of pediatrics
JF - journal of pediatrics
ER -
