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Children dependent on respiratory support: A 10-year review from one pediatric postacute care hospital
Helene M Dumas1, Mary Laurette Hughes1, Jane E O'Brien1
1Medical-Rehabilitation Research Center, Franciscan Children's Hospital, Boston, Massachusetts.
Insights
Pediatric postacute care hospitals are seeing more children needing respiratory support. While some children reduce their support, those with higher needs have longer stays and more admissions.
Area of Science:
- Pediatric healthcare
- Respiratory medicine
- Healthcare outcomes
Background:
- Pediatric postacute care hospitals (PACH) manage children with complex medical needs, including those requiring respiratory support.
- Data on the specific populations and outcomes for children dependent on respiratory support in PACH are limited.
- Understanding these trends is crucial for optimizing care delivery and resource allocation.
Purpose of the Study:
- To describe the demographics and respiratory support needs of children admitted to a US-based PACH.
- To analyze the longitudinal trends in respiratory support levels for these children.
- To evaluate the outcomes, specifically changes in respiratory support, during their postacute care stay.
Main Methods:
- A retrospective analysis of electronic health records from 2009 to 2018 was conducted.
- Children requiring respiratory support were identified based on hospital-defined levels of care.
- Outcomes were measured by the change in respiratory support level from initial admission to final discharge; admission numbers by level and year were also analyzed.
Main Results:
- The study included 1423 admissions for 767 children requiring respiratory support.
- Children with higher initial respiratory support needs (e.g., mechanical ventilation) had significantly more admissions and longer lengths of stay (P < .001).
- A significant reduction in the overall respiratory support level was observed from admission to discharge (z = -4.588, P < .001), alongside an increasing trend in admissions for children needing respiratory support, particularly the highest levels.
Conclusions:
- There is a notable and consistent rise in children admitted to PACH requiring respiratory support.
- While postacute care facilitates a reduction in respiratory support for some children, those with higher initial needs experience prolonged stays and recurrent admissions.
- These findings highlight the growing complexity of pediatric patients in postacute care settings and the need for specialized, long-term management strategies.
Objective:
Pediatric postacute care hospitals (PACH) provide long-term care for children with medical complexity including children dependent on respiratory support. Descriptions of PACH respiratory care populations and outcomes, however, remain under-reported. Our aim was to describe demographics, respiratory outcome, and longitudinal trend of children with respiratory support admitted to a single PACH in the United States.
Methods:
Using electronic records from 2009 to 2018, data were examined for all children dependent on respiratory support. Children were identified for inclusion using respiratory level of care classifications (type of support) as outlined in hospital policy. Outcome was defined as change in level from first admission to final discharge. Number of admissions by level and year during the study timeframe were analyzed.
Results:
There were 1423 admissions for 767 children requiring respiratory support during the study timeframe. Children with higher respiratory classification level (eg, mechanical ventilation) at initial admission had more admissions to PACH (P < .001) and longer length of stays (P < .001). From first admission to final discharge, there was a significant change (reduction) in respiratory level (z = -4.588, P < .001). An increase in the overall number of admissions for children with respiratory support during the study timeframe was noted, with the largest increase for children requiring the highest level of support.
Conclusion:
There has been a consistent increase in the number of children requiring respiratory support at admission to PACH. Reduction in respiratory support with postacute care occurs but children admitted with a higher level of support stay longer and experience multiple admissions.
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