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Risk factors associated with paediatric unplanned hospital readmissions: a systematic review
Huaqiong Zhou1,2, Pam A Roberts2, Satvinder S Dhaliwal3
1General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia.
Insights
Identifying risk factors for pediatric unplanned hospital readmissions is complex. Key factors include comorbidities, insurance type, and length of stay, highlighting the need for standardized predictive measures.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Clinical Epidemiology
Background:
- Unplanned hospital readmissions (UHRs) in children pose a significant challenge to healthcare systems.
- Understanding the multifactorial nature of pediatric UHRs is crucial for developing effective prevention strategies.
Purpose of the Study:
- To systematically synthesize existing evidence on risk factors associated with pediatric unplanned hospital readmissions.
- To identify common and condition-specific risk factors across all-cause, surgical, and general medical pediatric readmissions.
Main Methods:
- A systematic review of studies published between 2000 and 2017 was conducted.
- Searches were performed in CINAHL, EMBASE, and MEDLINE databases.
- Data were synthesized using content analysis due to study heterogeneity, with risk factors presented narratively.
Main Results:
- Forty-four studies identified 36 significant risk factors for pediatric UHRs.
- Commonly cited factors across all categories include comorbidity, public health insurance, longer length of stay (LOS), and specific age groups (<12 months, 13-18 years).
- Condition-specific factors varied, with ethnicity and insurance type prominent for all-cause, and procedure details, ASA class, and postoperative complications for surgical readmissions.
Conclusions:
- Predicting pediatric readmission risk is complex and influenced by study-specific variables.
- Comorbidity, public health insurance, longer LOS, and specific age groups are identified as overarching risk factors.
- Standardized measures for hospital discharge variables are needed to improve the prediction of pediatric UHRs.
Objective:
To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs).
Design:
Systematic review.
Data Source:
CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017.
Eligibility Criteria:
Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included.
Data Extraction And Synthesis:
Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form.
Results:
Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS.
Conclusions:
This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
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