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Discharge Before Return to Respiratory Baseline in Children With Neurologic Impairment
Rebecca Steuart1, Rachel Tan2, Katherine Melink2
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Discharging children with neurologic impairment before they return to their baseline respiratory status after an acute respiratory infection is common. However, this practice does not increase their risk of hospital readmission within 30 days.
Area of Science:
- Pediatric pulmonology
- Pediatric hospital medicine
- Healthcare quality and safety
Background:
- Children with neurologic impairment (NI) frequently experience hospitalizations for acute respiratory infections (ARI).
- These children often require ongoing respiratory support and may be discharged before fully recovering to their baseline respiratory function.
- Discharge timing relative to respiratory baseline is a critical consideration for this vulnerable population.
Purpose of the Study:
- To investigate the association between early discharge (before return to respiratory baseline) and 30-day hospital reutilization in children with NI hospitalized with ARI.
- To evaluate whether respiratory baseline status at discharge influences readmission rates for pediatric patients with complex respiratory needs.
Main Methods:
- A single-center retrospective cohort study analyzed 632 hospitalizations of children (aged 1-18 years) with NI and ARI requiring increased respiratory support (2010-2015).
- The primary exposure was discharge before return to respiratory baseline; the primary outcome was 30-day hospital reutilization.
- Generalized estimating equations accounted for within-patient clustering and clinical complexity.
Main Results:
- 30.4% of hospitalizations involved discharge before return to respiratory baseline.
- These early discharges were more common in privately insured, technology-dependent children with respiratory comorbidities.
- No significant difference in 30-day reutilization was observed between discharges before and at respiratory baseline (32.8% vs 31.8%; adjusted OR 0.80).
Conclusions:
- Discharge before return to respiratory baseline is frequent in children with NI hospitalized for ARI.
- This practice was not associated with an increased risk of 30-day hospital reutilization.
- Return to respiratory baseline may not be a mandatory discharge criterion for this patient group.
Background:
Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline.
Objective:
To determine if discharge before return to respiratory baseline is associated with reutilization among children with NI hospitalized with ARI.
Methods:
This single-center retrospective cohort study included children with NI aged 1 to 18 years hospitalized with ARI who required increased respiratory support between January 2010 and September 2015. The primary exposure was discharge before return to respiratory baseline. The primary outcome was 30-day hospital reutilization. A generalized estimating equation was used to examine the association between exposure and outcome while accounting for within-patient clustering and patient-level clinical complexity and illness severity.
Results:
In the 632 hospitalizations experienced by 366 children, children were discharged before return to respiratory baseline in 30.4% of hospitalizations. Compared with those hospitalizations in which children were discharged at baseline, hospitalizations with a discharge before return to respiratory baseline were more likely to be for privately insured, technology-dependent children with respiratory comorbidities. Compared with discharges at respiratory baseline, discharges with increased respiratory support had no difference in 30-day reutilization (32.8% vs 31.8%; P = .81; adjusted OR 0.80, 95% CI 0.51-1.26).
Conclusions:
Among children with NI hospitalized with ARI, discharge before return to respiratory baseline was common, but it was not associated with hospital reutilization. Return to respiratory baseline may not be a necessary component of discharge criteria in this population.
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