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Hospitalization for Community-Acquired Pneumonia in Children: Effect of an Asthma Codiagnosis
Karen M Wilson1, Michelle R Torok2, Russell Localio3
1Section of Pediatric Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado; Karen.wilson@childrenscolorado.org.
Insights
Community-acquired pneumonia (CAP) in children often co-occurs with acute asthma, leading to increased healthcare costs and longer hospital stays. Management and diagnostic variability are higher in these cases.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Clinical Informatics
Background:
- Community-acquired pneumonia (CAP) is a significant cause of pediatric hospitalization in the US.
- A notable proportion of children hospitalized with CAP also receive a codiagnosis of acute asthma.
- Understanding the implications of this codiagnosis is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To characterize demographic factors, costs, length of stay (LOS), and adherence to clinical guidelines in children hospitalized with CAP.
- To compare healthcare utilization and guideline adherence between children with CAP only and those with CAP and acute asthma.
Main Methods:
- A multicenter retrospective cohort study utilized data from the Pediatric Health Information System.
- Included were children aged 2-18 hospitalized with uncomplicated CAP between July 2007 and June 2012.
- Demographics, LOS, cost, and guideline adherence were compared between CAP-only and CAP-plus-asthma groups.
Main Results:
- Of 25,124 admissions, 57% had CAP only and 43% had CAP with acute asthma.
- CAP with acute asthma patients showed higher relative costs (11.8%) and LOS (5.6%) within hospitals.
- These patients also exhibited greater cost variation across hospitals and less frequent blood culture and more frequent incomplete CBC performance.
Conclusions:
- A codiagnosis of acute asthma in pediatric CAP is frequent, potentially due to misdiagnosis or true co-occurrence.
- Diagnostic and management variability is notably higher in children with CAP and acute asthma.
- This variability likely contributes to increased resource utilization and prolonged LOS for these patients.
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.
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