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Predictors of Hospitalization for Children With Croup, a Population-Based Cohort Study
Catherine M Pound1,2,3, Braden D Knight4,5,6,7, Richard Webster5,6
1Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; cpound@cheo.on.ca.
Insights
Predicting croup hospitalization in children is possible using factors like age, sex, and triage score. This research identifies key predictors and a tool to estimate risk for emergency department visits.
Area of Science:
- Pediatrics
- Emergency Medicine
- Health Informatics
Background:
- Croup is a common respiratory infection in children, frequently leading to emergency department (ED) visits.
- Predicting hospitalization risk for croup is crucial for resource allocation and timely intervention.
- Existing prediction models for croup hospitalization are limited.
Purpose of the Study:
- To identify predictors of hospitalization for pediatric croup in emergency departments.
- To determine factors associated with repeat ED visits and hospital readmissions for croup.
- To develop a practical tool for predicting croup hospitalization risk upon ED presentation.
Main Methods:
- Population-based cohort study using linked health administrative data from Ontario, Canada (2006-2017).
- Inclusion criteria: Children aged 0-5 years with at least one ED visit for croup.
- Multivariable logistic regression to identify predictors; development of a multivariable prediction tool.
Main Results:
- 3.3% of 54,981 eligible children were hospitalized for croup.
- Key predictors of hospitalization included age, sex, Canadian Triage and Acuity Scale score, gestational age, and newborn distress.
- Younger age and male sex predicted repeat ED visits for croup.
- The developed prediction tool could forecast hospitalization risk up to 32% probability.
Conclusions:
- This is the first population-based study identifying demographic and historical predictors of croup hospitalization.
- Symptom severity on ED presentation is important, but the prediction tool needs refinement for clinical use.
- Further research is needed to validate and implement the prediction tool in clinical practice.
Objectives:
We sought to determine predictors of hospitalization for children presenting with croup to emergency departments (EDs), as well as predictors of repeat ED presentation and of hospital readmissions within 18 months of index admission. We also aimed to develop a practical tool to predict hospitalization risk upon ED presentation.
Methods:
Multiple deterministically linked health administrative data sets from Ontario, Canada, were used to conduct this population-based cohort study between April 1, 2006 and March 31, 2017. Children born between April 1, 2006, and March 31, 2011, were eligible if they had 1 ED visit with a croup diagnosis. Multivariable logistic regression was used to determine factors associated with hospitalization, subsequent ED visits, and subsequent croup hospitalizations. A multivariable prediction tool and associated scoring system were created to predict hospitalization risk within 7 days of ED presentation.
Results:
Overall, 1811 (3.3%) of the 54 981 eligible children who presented to an Ontario ED were hospitalized. Significant hospitalization predictors included age, sex, Canadian Triage and Acuity Scale score, gestational age at birth, and newborn distress. Younger patients and boys were more likely to revisit the ED for croup. Our multivariable prediction tool could forecast hospitalization up to a 32% probability for a given patient.
Conclusions:
This study is the first population-based study in which predictors of hospitalization for croup based on demographic and historical factors are identified. Our prediction tool emphasized the importance of symptom severity on ED presentation but will require refinement before clinical implementation.
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