Predictors of pediatric readmissions among patients with neurological conditions

Abstract

Background Unplanned readmission is one of many measures of the quality of care of pediatric patients with neurological conditions. In this multicenter study, we searched for novel risk factors of readmission of patients with neurological conditions. Methods We retrieved hospitalization data of patients less than 18 years with one or more neurological conditions. This resulted in a total of 105,834 encounters from 18 hospitals. We included data on patient demographics, prior healthcare resource utilization, neurological conditions, number of other conditions/diagnoses, number of medications, and number of surgical procedures performed. We developed a random intercept logistic regression model using stepwise minimization of Akaike Information Criteria for variable selection. Results The most important neurological conditions associated with unplanned pediatric readmissions include hydrocephalus, inflammatory diseases of the central nervous system, sleep disorders, disease of myoneural junction and muscle, other central nervous system disorder, other spinal cord conditions (such as vascular myelopathies, and cord compression), and nerve, nerve root and plexus disorders. Current and prior healthcare resource utilization variables, number of medications, other diagnoses, and certain inpatient surgical procedures were associated with changes in odds of readmission. The area under the receiver operator characteristic curve (AUROC) on the independent test set is 0.733 (0.722, 0.743). Conclusions Pediatric patients with certain neurological conditions are more likely to be readmitted than others. However, current and prior healthcare resource utilization remain some of the strongest indicators of readmission within this population as in the general pediatric population.

Demographics and Risk Factors of Pediatric Pulmonary Hypertension Readmissions

“…Similar to other studies, this study showed that patients with Medicaid as their primary insurance had a higher likelihood of readmission [ 27 , 28 ]. A study in the adult population has shown that about half of the Medicaid patients did not have an outpatient follow-up between their initial visit and unplanned 30-day readmission [ 29 ].…”

Applicability of predictive models for 30-day unplanned hospital readmission risk in paediatrics: a systematic review

“…The significant risk factors were inconsistently defined across predictive models, allowing a direct comparison only to a limited extent. ORs for comorbidity ranged from 1.01 72 to 10.08 58 across predictive models. A length of stay of ≥15 days (OR=2.39) 61 and a postoperative length of stay of >4 days (hazard ratio=3.12) 56 were considered to be a major risk factor.…”

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

“…bronchial asthma, seizure disorders, nephrotic syndrome and congenital heart diseases, requiring more frequent readmissions than one-time events, e.g . infections 15 , 33 . Similarly, the disorders with high mortality will expectedly have lower readmission rates.…”

“…Similarly, the disorders with high mortality will expectedly have lower readmission rates. While there is a paucity of Indian literature on this aspect, many studies from the developed countries have also reported the age, diagnosis on index admission and presence of chronic conditions as risk factors for readmissions in children 3 , 7 , 30 , 31 , 33 - 37 . Some others have also found gender, length of hospital stay during the index admission, number of past admissions and presence of comorbidities as significant risk factors for readmissions 3 , 32 , 35 , 36 , 38 , 39 .…”