Risk factors for nonelective 30-day readmission in pediatric assault victims

Jessica L. Buicko, Joshua Parreco, Brent A. Willobee, Amy E. Wagenaar, Juan E Sola

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. Methods: The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18. years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. Results: There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30. days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >. 7. days (OR 3.028, p. <. 0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p. <. 0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p. <. 0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). Conclusions: Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. Level of evidence: Level IV - Prognostic and Epidemiological - Retrospective Study.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Nov 30 2016

Fingerprint

Pediatrics
Odds Ratio
Psychotic Disorders
Patient Readmission
Wounds and Injuries
Weight Loss
Databases
Patient Discharge
Major Depressive Disorder
Bipolar Disorder
Health Care Costs
Epidemiologic Studies
Length of Stay
Hospitalization
Outpatients
Retrospective Studies
Logistic Models
Morbidity
Delivery of Health Care
Education

Keywords

  • Assault
  • Quality improvement
  • Readmission
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Risk factors for nonelective 30-day readmission in pediatric assault victims. / Buicko, Jessica L.; Parreco, Joshua; Willobee, Brent A.; Wagenaar, Amy E.; Sola, Juan E.

In: Journal of Pediatric Surgery, 30.11.2016.

Research output: Contribution to journalArticle

Buicko, Jessica L. ; Parreco, Joshua ; Willobee, Brent A. ; Wagenaar, Amy E. ; Sola, Juan E. / Risk factors for nonelective 30-day readmission in pediatric assault victims. In: Journal of Pediatric Surgery. 2016.
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abstract = "Purpose: Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. Methods: The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18. years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. Results: There were 4050 pediatric victims of assault and 92 (2.27{\%}) died during the initial admission. Of the surviving patients 128 (3.23{\%}) were readmitted within 30. days. Of these readmitted patients 24 (18.75{\%}) were readmitted to a different hospital and 31 (24.22{\%}) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >. 7. days (OR 3.028, p. <. 0.01, 95{\%} CI 1.67-5.50), psychoses (OR 3.719, p. <. 0.01, 95{\%} CI 1.70-8.17), and weight loss (OR 4.408, p. <. 0.01, 95{\%} CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2{\%}), post-operative, posttraumatic, or other device infections (6.2{\%}), or major depressive disorders and other/unspecified psychoses (5.2{\%}). Conclusions: Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. Level of evidence: Level IV - Prognostic and Epidemiological - Retrospective Study.",
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AU - Sola, Juan E

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Y1 - 2016/11/30

N2 - Purpose: Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. Methods: The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18. years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. Results: There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30. days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >. 7. days (OR 3.028, p. <. 0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p. <. 0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p. <. 0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). Conclusions: Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. Level of evidence: Level IV - Prognostic and Epidemiological - Retrospective Study.

AB - Purpose: Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. Methods: The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18. years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. Results: There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30. days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >. 7. days (OR 3.028, p. <. 0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p. <. 0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p. <. 0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). Conclusions: Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. Level of evidence: Level IV - Prognostic and Epidemiological - Retrospective Study.

KW - Assault

KW - Quality improvement

KW - Readmission

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