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Published on: April 7, 2021
Readmission Rates After Acute Respiratory Distress Syndrome in Children
Garrett Keim1,2,3, Jesse Y Hsu4, Neethi P Pinto1,2
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Pediatric survivors of acute respiratory distress syndrome (ARDS) face a high 1-year readmission rate of 30%. Chronic conditions, tracheostomy, and prolonged hospital stays significantly increase readmission risk in these children.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Health services research
Background:
- An increasing number of children survive acute respiratory distress syndrome (ARDS).
- Long-term morbidity, including hospital readmission rates and associated factors, for pediatric ARDS survivors remains largely unknown.
- Understanding these factors is crucial for improving post-discharge care and reducing healthcare burdens.
Purpose of the Study:
- To determine the 1-year hospital readmission rates among pediatric ARDS survivors.
- To investigate the association of index hospitalization factors—complex chronic conditions, tracheostomy, and length of stay (LOS)—with 1-year readmission.
Main Methods:
- Retrospective cohort study utilizing IBM MarketScan databases (2013-2018).
- Included children (≥28 days to <18 years) with mechanically ventilated ARDS who survived to discharge.
- Cox proportional hazard models analyzed associations between hospitalization factors and 1-year all-cause readmission.
Main Results:
- The 1-year readmission rate was 30.0% among 13,505 pediatric ARDS survivors.
- Readmissions were concentrated within 61 days of discharge.
- Both respiratory and nonrespiratory complex chronic conditions, tracheostomy, and LOS ≥14 days were significantly associated with increased readmission risk.
Conclusions:
- Pediatric ARDS survivors have a substantial burden of 1-year hospital readmissions.
- Presence of complex chronic conditions, tracheostomy placement, and prolonged index hospitalization are key predictors of readmission.
- Further research into post-discharge interventions is warranted to mitigate readmission rates.
Importance:
An increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown.
Objective:
To determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission.
Design, Setting, And Participants:
This retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to <18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023.
Exposures:
Complex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS.
Main Outcomes And Measures:
The primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission.
Results:
One-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47).
Conclusions And Relevance:
In this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.
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