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Pre- and Post-admission Care for Children Hospitalized With Skin and Soft Tissue Infections
Lisa Rickey1,2, Matt Hall3, Jay G Berry1,2
1Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston.
Insights
Children hospitalized for skin and soft tissue infections (SSTIs) benefited from earlier outpatient care, leading to shorter hospital stays. Optimizing access to this pre-admission care is crucial for pediatric SSTI management.
Area of Science:
- Pediatric infectious diseases
- Health services research
- Antibiotic stewardship
Background:
- Skin and soft tissue infections (SSTIs) are a frequent reason for pediatric hospitalizations.
- Understanding outpatient care patterns before and after hospitalization for SSTIs is limited.
- The impact of peri-hospitalization antibiotic use on hospital length of stay (LOS) requires investigation.
Purpose of the Study:
- To assess outpatient care utilization for pediatric SSTIs around the time of hospitalization.
- To examine the association between pre-hospitalization care and hospital LOS.
- To evaluate the influence of antibiotic exposures on LOS for pediatric SSTI admissions.
Main Methods:
- Retrospective cohort study of 1229 pediatric SSTI hospitalizations (ages 1-18) using Medicaid data from 2019.
- Analysis of health service utilization 14 days before and 30 days after hospitalization.
- Linear regression models used to evaluate the effect of pre-hospitalization care on LOS.
Main Results:
- Only 43.1% of hospitalizations had a preceding outpatient visit for SSTI; 69.8% of these involved antibiotic prescriptions.
- Median LOS for SSTI admission was 2 days.
- Pre-hospitalization SSTI visits were linked to a 0.7-day reduction in LOS (P < .001); pre-hospital antibiotic exposure alone did not affect LOS.
Conclusions:
- Most children hospitalized for SSTIs do not receive pre-admission outpatient care.
- Pre-admission outpatient visits for SSTI are associated with shorter hospitalizations.
- Further research is needed to optimize access and utilization of outpatient care for pediatric SSTIs.
Background And Objectives:
Although skin and soft tissue infections (SSTIs) are among the most common indications for pediatric hospitalization, little is known about outpatient care received for SSTI before and after hospitalization. We assessed peri-hospitalization care for SSTI, including antibiotic exposures and their impact on hospital length of stay (LOS).
Methods:
This is a retrospective cohort study of 1229 SSTI hospitalizations in 2019 from children aged 1-to-18 years enrolled in Medicaid from 10 US states included in the Merative Marketscan Medicaid database. We characterized health service utilization (outpatient visits, laboratory and diagnostic tests, antibiotic exposures) 14 days before and 30 days after hospitalization and evaluated the effects of pre-hospitalization care on hospital LOS with linear regression.
Results:
Only 43.1% of children hospitalized with SSTI had a preceding outpatient visit with a SSTI diagnosis, 69.8% of which also filled prescription for an antibiotic. Median LOS for SSTI admission was 2 days (interquartile range 1-3). Pre-hospitalization visits with a diagnosis of SSTI were associated with a 0.7 day reduction (95% confidence interval: 0.6-0.81) in LOS (P < .001), but pre-hospital antibiotic exposure alone had no effect on LOS. Most children (81.7%) filled antibiotic prescriptions after hospital discharge and 74.5% had post-discharge ambulatory visits.
Conclusions:
Although most children did not receive pre-admission care for SSTI, those that did had a shorter hospitalization. Further investigation is necessary on how to optimize access and use of outpatient care for SSTI.
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