Hospital Readmissions Among Children With H1N1 Influenza Infection

Abstract

Objectives: To describe readmissions among children hospitalized with H1N1 (influenza subtype, hemagglutinin1, neuraminidase 1) pandemic influenza and secondarily to determine the association of oseltamivir during index hospitalization with readmission. Methods: We reviewed data from 42 freestanding children’s hospitals contributing to the Pediatric Health Information System from May through December 2009 when H1N1 was the predominant influenza strain. Children were divided into 2 groups by whether they experienced complications of influenza during index hospitalization. Primary outcome was readmission at 3, 7, and 30 days among both patient groups. Secondary outcome was the association of oseltamivir treatment with readmission. Results: The study included 8899 children; 6162 patients had uncomplicated index hospitalization, of whom 3808 (61.8%) received oseltamivir during hospitalization, and 2737 children had complicated influenza, of whom 1055 (38.5%) received oseltamivir. Median 3-, 7-, and 30-day readmission rates were 1.6%, 2.5%, and 4.7% for patients with uncomplicated index hospitalizations and 4.3%, 5.8%, and 10.3% among patients with complicated influenza. The 30-day readmission rates did not differ by treatment group among patients with uncomplicated influenza; however, patients with complicated index hospitalizations who received oseltamivir had lower all-cause 30-day readmissions than untreated patients. The most common causes of readmission were pneumonia and asthma exacerbations. Conclusions: Oseltamivir use for hospitalized children did not decrease 30-day readmission rates in children after uncomplicated index hospitalization but was associated with a lower 30-day readmission rate among children with complicated infections during the 2009 H1N1 pandemic. Readmission rates for children who had complicated influenza infection during index hospitalizations are high.

Dose‐response relationship between weight status and clinical outcomes in pediatric influenza‐related respiratory infections

“…A multicenter retrospective study in the United States revealed that pneumonia/bronchitis, acute asthma exacerbation, empyema, acute respiratory failure, and sepsis were the main reasons for repeated admission among inpatients with influenza infections at index admission . The study also found complications of influenza infections during the index admission, non‐use of neuraminidase inhibitors, and underlying complex chronic medical conditions to be risk factors for repeated admission . However, the relationship between pediatric weight status and readmission because of respiratory infections remains unclear.…”

“…23 The study also found complications of influenza infections during the index admission, non-use of neuraminidase inhibitors, and underlying complex chronic medical conditions to be risk factors for repeated admission. 23 national estimates of the effects of obesity on influenza-related respiratory infections among pediatric inpatients.…”

“…Data on risk factors associated with re admissions for children hospitalized with influenza infections are scarce. A multicenter retrospective study in the United States revealed that pneumonia/bronchitis, acute asthma exacerbation, empyema, acute respiratory failure, and sepsis were the main reasons for repeated admission among inpatients with influenza infections at index admission . The study also found complications of influenza infections during the index admission, non‐use of neuraminidase inhibitors, and underlying complex chronic medical conditions to be risk factors for repeated admission .…”

Early Use of Anti-influenza Medications in Hospitalized Children With Tracheostomy

“…These ICD-9-CM codes have been previously used to identify hospitalized pediatric patients with the presence of tracheostomy 19,21,25 and laboratoryconfirmed influenza with high specificity and positive predictive value. [26][27][28][29] We excluded patients with any of the following characteristics: (1) age 20 years or older to exclude adult patients; (2) transfer from an outside hospital with inpatient status, given interest in initial treatment of influenza and length of stay (LOS); (3) extreme outliers in LOS defined as median plus 3 times the interquartile range (IQR); (4) death during the index hospitalization because the patients could not have a revisit; (5) presence of surgical procedures unrelated to influenza within first 2 days of hospitalization to minimize the possibility of including patients who acquired or manifested with influenza infection during hospitalizations for other reasons; or (6) missing variables in the database. To prevent overrepresentation by patients with multiple eligible encounters, we first assigned a computer-generated random whole number to each admission episode and subsequently selected 1 admission episode for each patient for analysis.…”

Risk Factors of Readmission to Hospital for Pneumonia in Children

“…재입원에 대한 관심이 높아 재입원에 대한 광범위한 통계 적 연구 1,3) 및 소아 천식 4) , 인플루엔자 환자에 대한 연구 5) 를 비롯하여 폐렴 환자에 대한 연구 6,7) 등 활발한 접근이 이루어지고 있다.…”