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Admissions for Pediatric Somatic Symptom and Related Disorders: A National Database Study
Nicole E Kelly1,2,3, Anjile An4, Katherine A Nash2
1NewYork-Presbyterian Hospital, New York, New York.
Insights
Annual hospitalizations for pediatric somatic symptom and related disorders (SSRDs) impact diverse youth. Factors like multiple diagnoses and insurance type influence healthcare utilization and costs.
Area of Science:
- Pediatric Health Services Research
- Child and Adolescent Psychiatry
- Healthcare Disparities
Background:
- Pediatric somatic symptom and related disorders (SSRDs) significantly affect young patients' well-being and can necessitate inpatient care.
- Limited national data exists on the prevalence and healthcare utilization patterns of pediatric SSRDs in inpatient settings within the U.S.
Purpose of the Study:
- To determine the prevalence and demographic characteristics of pediatric patients admitted for SSRDs.
- To analyze healthcare utilization, including length of stay and cost, for these admissions.
- To identify factors associated with high healthcare utilization among pediatric SSRD inpatients.
Main Methods:
- Utilized data from the Pediatric Health Information System (PHIS) for inpatient encounters between 2016 and 2023.
- Included patients aged 5 to 21 years with an admitting or primary SSRD diagnosis.
- Employed descriptive statistics and multivariable logistic regression to identify predictors of high utilization (e.g., readmission, prolonged length of stay, high cost).
Main Results:
- Analyzed 6,820 encounters across 48 hospitals, revealing a diverse patient population (predominantly 12-18 years old, female, non-Hispanic white).
- Identified associations between multiple diagnoses (≥7) and Northeast hospitalization with increased odds of prolonged LOS, high cost, and readmission.
- Hispanic patients showed higher odds of high-cost admissions, while commercial insurance and comorbid anxiety were linked to prolonged LOS.
Conclusions:
- Approximately 853 annual admissions for pediatric SSRDs occur across U.S. tertiary children's hospitals, affecting a sociodemographically varied group.
- Significant disparities in healthcare utilization exist, necessitating further research into their underlying drivers.
- Understanding these utilization patterns is crucial for optimizing care and addressing inequities in pediatric mental healthcare.
Objective:
Pediatric somatic symptom and related disorders (SSRDs) negatively impact patients' lives and can lead to hospitalization. No national U.S. studies have examined inpatient SSRD prevalence and health care utilization. We aimed to report demographic characteristics and health care utilization of patients admitted for pediatric SSRDs using the Pediatric Health Information System (PHIS) and identify characteristics associated with high utilization.
Methods:
We included inpatient encounters from 2016 through 2023 for patients 5 to 21 years old with an admitting or primary SSRD diagnosis. We used descriptive statistics to summarize patient- and encounter-level variables and multivariable logistic regression to identify factors independently associated with high utilization (readmission or >75th percentile length of stay [LOS] or cost).
Results:
There were 6820 encounters and 6297 patients from 48 hospitals. Most patients were 12 to 18 years old (n = 4889, 78%), female (74%, n = 4666), and non-Hispanic white (55%, n = 3449). Median LOS was 2 days (IQR, 1-4), and median encounter cost was $7946 (IQR, 4737-13 701). Four hundred sixteen patients (7%) had multiple admissions. Carrying 7 or more diagnoses and Northeast hospitalization were associated with higher odds of prolonged LOS, high cost, and readmission. Odds of prolonged LOS alone were higher with commercial insurance (odds ratio [OR], 1.19 [95% CI, 1.03-1.36]) and comorbid anxiety (OR, 1.29 [95% CI, 1.10-1.51]). Hispanic patients had higher odds of high-cost admission (OR, 1.57 [95% CI, 1.24-1.99]) compared with non-Hispanic white patients.
Conclusions:
An average of 853 admissions for SSRDs occur annually across 48 US tertiary care children's hospitals and affect a sociodemographically diverse population. Further investigation into drivers of disparate health care utilization is needed.
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