Hospitalization for Community-Acquired Pneumonia in Children: Effect of an Asthma Codiagnosis
| Autor: | Russell Localio, Lisa McLeod, Michelle Torok, Zeinab Mohamad, Rajendu Srivastava, Xianqun Luan, Samir S. Shah, Karen M. Wilson |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Comorbidity Pediatrics Community-acquired pneumonia Internal medicine Health care medicine Humans Blood culture Hospital Costs Child Intensive care medicine Retrospective Studies Asthma medicine.diagnostic_test business.industry Complete blood count Retrospective cohort study Pneumonia General Medicine Length of Stay medicine.disease United States Community-Acquired Infections Hospitalization Child Preschool Practice Guidelines as Topic Pediatrics Perinatology and Child Health Female Guideline Adherence business |
| Zdroj: | Hospital Pediatrics. 5:415-422 |
| ISSN: | 2154-1671 2154-1663 |
| DOI: | 10.1542/hpeds.2015-0007 |
| Popis: | BACKGROUND AND OBJECTIVE: Community-acquired pneumonia (CAP) is a common and expensive cause of hospitalization among US children, many of whom receive a codiagnosis of acute asthma. The objective of this study was to describe demographic characteristics, cost, length of stay (LOS), and adherence to clinical guidelines among these groups and to compare health care utilization and guideline adherence between them. METHODS: This was a multicenter retrospective cohort study using data from the Pediatric Health Information System. Children aged 2 to 18 who were hospitalized with uncomplicated CAP from July 1, 2007, to June 30, 2012 were included. Demographics, LOS, total standardized cost, and clinical guideline adherence were compared between patients with CAP only and CAP plus acute asthma. RESULTS: Among the 25 124 admissions, 57% were diagnosed with CAP only; 43% had a codiagnosis of acute asthma. The geometric mean for standardized cost was $4830; for LOS, it was 2.01 days. Eighty-four percent of patients had chest radiographs; CAP+acute asthma patients were less likely to have a blood culture performed (36% vs 62%, respectively) and more likely not to have a complete blood count performed (49% vs 27%, respectively). Greater guideline adherence was associated with higher cost at the patient-level but lower average cost per hospitalization at the hospital level. CAP+acute asthma patients had higher relative costs (11.8%) and LOS (5.6%) within hospitals and had more cost variation across hospitals, compared with patients with CAP only. CONCLUSIONS: A codiagnosis of acute asthma is common for children with CAP. This could be from misdiagnosis or co-occurrence. Diagnostic and/or management variability appears to be greater in patients with CAP+asthma, which may increase resource utilization and LOS for these patients. |
| Databáze: | OpenAIRE |
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