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Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy
Christopher J Russell1,2, Cary Thurm3, Matt Hall3
1Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Young, Hispanic children with multiple chronic conditions face higher hospital readmission risks for bacterial respiratory tract infections (bRTI) after tracheotomy. Identifying these risk factors is crucial for targeted interventions and improved patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Health services research
Background:
- Tracheotomy is a critical intervention for pediatric patients with respiratory compromise.
- Bacterial respiratory tract infections (bRTI) are a significant cause of morbidity and mortality in children with tracheotomies.
- Understanding risk factors for hospital readmission due to bRTI post-tracheotomy is essential for optimizing care and reducing healthcare burden.
Purpose of the Study:
- To identify demographic and clinical characteristics associated with hospital readmission due to bRTI in children following tracheotomy.
- To inform targeted interventions aimed at reducing readmission rates for this vulnerable population.
Main Methods:
- Retrospective study utilizing the Pediatric Health Information System database.
- Inclusion of 8009 children aged 0-17 years who underwent tracheotomy between 2007 and 2013.
- Cox-proportional hazard modeling to analyze associations between patient characteristics and bRTI readmission.
Main Results:
- 36% of patients experienced at least one bRTI readmission, with a median time to readmission of 275 days.
- Increased risk of bRTI readmission was associated with younger age (under 30 days), Hispanic ethnicity, government insurance, and more than two complex chronic conditions.
- Trauma diagnosis at tracheotomy and ventilator dependency were associated with a decreased risk of bRTI readmission.
Conclusions:
- Young, Hispanic children with multiple complex chronic conditions, government insurance, and discharged home are at the highest risk for bRTI readmission post-tracheotomy.
- These findings highlight the need for focused preventative strategies and support for high-risk pediatric patients.
- Further research is warranted to develop and evaluate interventions to mitigate bRTI readmission risk in this population.
Objective:
Identify characteristics associated with hospital readmission due to bacterial respiratory tract infections (bRTI) after tracheotomy.
Study Design:
Retrospective study of 8009 children 0-17 years undergoing tracheotomy from 2007 to 2013 at 48 children's hospitals in the Pediatric Health Information System database. The primary outcome was first hospital admission after tracheotomy for bRTI (ie, primary diagnosis of bRTI or a primary diagnosis of bRTI symptom and secondary diagnosis of bRTI). We used Cox-proportional hazard modeling to assess associations between patient demographic and clinical characteristics and bRTI hospital readmission.
Results:
Median age at tracheotomy admission was 5 months (interquartile range [IQR]: 1-50 months). Thirty-six percent (n = 2899) had at least one bRTI admission. Median time-to-readmission for bRTI was 275 days (IQR: 141-530). Factors independently associated with increased risk for bRTI readmission were younger age (eg, age < 30 days vs 13-17 years [aHR 1.32; 95%CI: 1.11-1.58]), Hispanic race/ethnicity (vs non-Hispanic White; aHR: 1.34; 95%CI: 1.20-1.50), government insurance (vs private; aHR 1.21; 95%CI: 1.10-1.33), >2 complex chronic conditions (vs zero; aHR 1.96; 95%CI: 1.34-2.86) and discharge to home (vs post-acute care setting; aHR 1.19; 95%CI: 1.08-1.32). Trauma diagnosis at tracheotomy (aHR 0.83; 95%CI: 0.69-1) and ventilator dependency (aHR 0.88; 95%CI: 0.81-0.97) were associated with decreased risk.
Conclusions:
Young, Hispanic children with multiple complex chronic conditions who use Medicaid insurance and are not discharged to post-acute care are at the highest risk for hospital readmission for bRTI post-tracheotomy. Future research should investigate strategies to mitigate this risk for these children.
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