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Severity assessment in children hospitalized with bronchiolitis using the pediatric component of the Comprehensive
D F Willson1, S D Horn, R Smout
1Division of Pediatric Critical Care, University of Virginia Children's Medical Center, Charlottesville, USA.
Insights
The Comprehensive Severity Index (CSI) effectively correlates with resource utilization in hospitalized children with bronchiolitis. This tool can help assess the cost-effectiveness of pediatric care for this common respiratory illness.
Area of Science:
- Pediatrics
- Health Services Research
- Medical Informatics
Background:
- Practice variations in managing pediatric bronchiolitis can lead to significant differences in resource utilization.
- Objective assessment of severity is crucial for determining cost-effective care strategies.
Purpose of the Study:
- To examine the correlation between the pediatric component of the Comprehensive Severity Index (CSI) and resource utilization in children hospitalized with bronchiolitis.
- To evaluate the utility of CSI in assessing cost-effectiveness of care for pediatric bronchiolitis.
Main Methods:
- Retrospective chart review of 804 children with bronchiolitis across 10 children's medical centers.
- Collected data included demographics, clinical findings, interventions, and outcomes.
- Correlated CSI scores (admission and maximum) with resource utilization measures (costs, length of stay, PICU admission, intubation) and compared with Pediatric Risk of Mortality III.
Main Results:
- Maximum CSI scores showed the highest correlation with hospital costs (r2=0.42) and length of stay (r2=0.41).
- Admission CSI scores demonstrated comparable correlation to aggregate patient variables for costs and length of stay.
- CSI scores correlated well with resource utilization in subgroups of patients with comorbidities or risk factors for severe disease.
Conclusions:
- CSI scores demonstrate a strong correlation with resource use in pediatric patients hospitalized for bronchiolitis.
- The CSI severity scoring system shows potential utility in evaluating the cost-effectiveness of care for pediatric bronchiolitis.
Objective:
Practice variation in the management of children hospitalized with bronchiolitis may result in significant differences in resource utilization. Determination of cost-effective care requires an objective means of adjusting for severity. We examined the correlation of the pediatric component of the Comprehensive Severity Index (CSI) with resource utilization in children hospitalized with bronchiolitis at ten children's medical centers.
Design:
Demographics, clinical findings, laboratory results, interventions, and outcomes were retrospectively extracted from the charts of 804 consecutive children with International Classification of Disease, Ninth Revision codes for bronchiolitis from 10 children's medical centers. Comorbidities of prematurity, heart disease, and a prior history of wheezing or hospitalization, and the viral etiology of the illness were specifically examined. CSI scoring was performed at admission and maximum and correlated with patient variables and measures of resource utilization (hospital costs, length of stay, pediatric intensive care unit admission, and intubation). The performance of CSI relative to the Pediatric Risk of Mortality III was also evaluated.
Setting:
Ten tertiary children's medical centers.
Interventions:
None.
Measurements And Main Results:
One child died and >99% of children returned to their baseline state of health. Admission CSI was comparable to the aggregate of all patient variables in its correlation with hospital costs (r2 = 0.23 vs. r2 = 0.24, respectively) and lengths of stay (r2 = 0.23 vs. r2 = 0.24, respectively). Maximum CSI had the highest correlation coefficient with hospital costs (r2 = 0.42) and lengths of stay (r2 = 0.41), whereas the correlation of admission Pediatric Risk of Mortality III scores with costs was r2 = 0.12 and with lengths of stay was r2 = 0.07. CSI scores also correlated well with measures of resource utilization in subgroups of bronchiolitis patients with comorbidities or other risk factors for severe disease.
Conclusions:
CSI scores correlate well with resource use in pediatric patients hospitalized with bronchiolitis. This severity scoring system may be useful in assessing the cost-effectiveness of their care.
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