ABSTRACT
OBJECTIVE: To identify variables associated with return visits to the hospital within 7 days after discharge. METHODS: We performed a retrospective study of 7-day revisits and readmissions between October 2012 and September 2015 using the Pediatric Health Information System database supplemented by electronic medical record data from a tertiary-care children's hospital. We examined factors associated with revisits among the top 10 most frequent indications for hospitalization using generalized estimating equations. RESULTS: There were 736 (4.2%) revisits and 416 (2.3%) readmissions within 7 days. Predictors of 7-day revisits and readmissions included age, length of hospital stay, and presence of a chronic medical condition. In addition, insurance status was associated with risk of revisits and race was associated with risk of readmissions in the bivariate analysis. CONCLUSIONS: In this study, we identified patient characteristics that may be associated with a higher risk of early return to the emergency department and/or readmissions. Early identification of this at-risk group of patients may provide opportunities for intervention and enhanced care coordination at discharge.
Subject(s)
Patient Discharge , Patient Readmission , Age Factors , Child , Chronic Disease , Emergency Service, Hospital , Hospitals , Hospitals, Pediatric , Humans , Insurance Coverage , Length of Stay , Racial Groups , Retrospective Studies , Risk Factors , Tertiary Care CentersABSTRACT
BACKGROUND AND OBJECTIVES: Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes. METHODS: This multicenter retrospective cohort study included children ≥2 months and <18 years discharged with complicated pneumonia between 2009 and 2012. The main exposure was the route of postdischarge antibiotic administration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits." RESULTS: Among 2123 children, 281 (13.2%) received antibiotics via PICC. Treatment failure rates were 3.2% among PICC and 2.6% among oral antibiotic recipients and were not significantly different between the groups in across-hospital-matched analysis (matched odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54 to 2.94). PICC complications occurred in 7.1%. Adverse drug reactions occurred in 0.6% of children; PICC antibiotic recipients had greater odds of adverse drug reaction in across hospital matched analysis (matched OR, 19.1; 95% CI, 4.2 to 87.3). The high rate of PICC complications and differences in adverse drug reactions contributed to higher odds of the composite outcome of all related revisits among PICC antibiotic recipients (matched OR, 4.71; 95% CI, 2.97 to 7.46). CONCLUSIONS: Treatment failure rates between PICC and oral antibiotics did not differ. Children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Catheterization, Peripheral/adverse effects , Pneumonia/drug therapy , Administration, Intravenous , Administration, Oral , Adolescent , Anti-Bacterial Agents/adverse effects , Child , Child, Preschool , Cohort Studies , Humans , Infant , Patient Discharge , Retrospective Studies , Treatment FailureABSTRACT
Witnessing a seizure is not something you're likely to forget, but as a bedside nurse it's something you're bound to experience. Seizures are a transient disruption in brain function caused by excessive electrical discharge of cortical neurons in one or more areas of the brain. They affect an estimated 2.5 million Americans. Each year in the United States, 300,000 people-120,000 of them younger than 18-have a seizure for the first time, and about 181,000 people are diagnosed with epilepsy.