Risk factors associated with paediatric unplanned hospital readmissions: a systematic review

Abstract

ObjectiveTo synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs).DesignSystematic review.Data sourceCINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017.Eligibility criteriaStudies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included.Data extraction and synthesisCharacteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form.ResultsThirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS.ConclusionsThis systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13–18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.

Using machine learning to predict paediatric 30-day unplanned hospital readmissions: a case-control retrospective analysis of medical records, including written discharge documentation

“…This retrospective cohort study used historical data from 2010 to 2014, which may reduce the relevance to current clinical practice. However, risk factors associated with paediatric unplanned hospital readmissions have remained stable over the last decade, based on our recently published systematic review, 1 indicating that the datasets used in this study provided relevant information regarding current readmission factors.…”

“…The identification of predictive factors associated with paediatric unplanned readmission to hospital can be used to improve discharge planning processes, and thereby help prevent such readmissions. Prior research has uncovered many of these factors; a recent systematic review 1 of the existing literature extracted 36 unique predictors associated with paediatric unplanned hospital readmissions from 44 studies. The most commonly cited four predictors were comorbidity, health insurance status, length of stay (LOS), and age at the index admission.…”

Risk factors associated with 30‐day all‐cause unplanned hospital readmissions at a tertiary children's hospital in Western Australia

“…This is similar to findings from this study, which identified that patients older than 13 years were nearly 1.5 times more likely to be readmitted compared with younger patients. This may be related to adolescents and young adults with underlying chronic health conditions Further research is recommended to examine whether, potentially, some unplanned hospital readmissions may be unavoidable due to medical complexity…”

“…Unplanned hospital readmission rate has been widely accepted as a service performance indicator to evaluate the quality of health‐care delivery . A recent systematic review examined research evidence on paediatric unplanned hospital readmissions from 2000 to 2017. Some American studies used 365 days to measure the all‐cause unplanned readmissions, and the prevalence was from 16.7 to 21.8% .…”

Epidemiology of readmissions in early infancy following nonelective cesarean delivery

“…discharge planning, transition of care between inpatient and outpatient providers), but have not been endorsed to date for neonatal care, primarily because of a lack of agreement between study teams of what constitutes “preventable” readmissions. 1 , 2 , 3 , 4 , 5 Readmissions and emergency department visits of very premature, moderate preterm, late preterm, and early term infants have been studied by many investigators. 6 , 7 , 8 However, term infants account for many readmissions, for they comprise the majority (~90%) of live births, but readmissions of term infants have not been as well studied.…”