Factors Associated With Exceeding Predicted Hospital Stays in Pediatric Trauma Patients

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Health Services Research

Background:

• The Center for Medicare and Medicaid Services (CMS) uses predicted length of stay (LOS) for reimbursement.
• Injury Severity Score (ISS) and non-accidental trauma (NAT) are linked to longer hospital stays in pediatric trauma patients.
• Factors impacting CMS-predicted LOS in pediatric trauma are not fully understood.

Purpose of the Study:

• Identify factors influencing CMS-predicted LOS in pediatric trauma patients.
• Determine if practice changes can reduce actual LOS.
• Inform strategies for improving LOS predictions and reducing actual LOS.

Main Methods:

• Retrospective chart review of 1005 pediatric trauma patients (January 2018 - December 2020).
• Analysis of patient data, including demographics, injury characteristics, and hospital course.
• Statistical analysis with significance set at P < .05.

Main Results:

• 17.6% of patients exceeded their CMS-predicted LOS.
• Excessive LOS associated with higher ISS, confirmed NAT, child protective services involvement, ICU admissions, intubations, ventilator days, transfusions, and inpatient rehabilitation discharges.
• Etiologies like motor-vehicle crashes and suspected abuse, along with brain and internal organ injuries, correlated with longer stays.
• Increased imaging studies, surgical procedures, and longer operative times were noted in patients with excessive LOS.

Conclusions:

• A significant proportion of pediatric trauma patients exceed CMS-predicted LOS, impacting hospital reimbursement.
• Factors related to patient demographics, trauma etiology, and inpatient care influence excessive LOS.
• Addressing identified factors can improve LOS predictions and potentially reduce actual LOS.