Thirty‐day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

Abstract

Background Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children’s Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. Procedure We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children’s hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. Results We identified 4,762 patients with 12,104 qualifying hospitalizations (1–30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. Conclusions In a sample of free-standing children’s hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used.

Sickle cell pain: a critical reappraisal

“…Sobota et al identified 4762 patients with 12 104 qualifying hospitalizations of which 2074 hospitalizations (17%) were readmissions for sickle cell crisis within 30 days after discharge. 65 Risk markers for readmission included older children, pain, and treatment with steroids.…”

“…62 Moreover, the high frequency of hospital readmission was confirmed by other studies. [63][64][65] In a retrospective cohort of SCD-related ED visits and hospitalizations from 8 states in 2005 and 2006, Brousseau et al found that the 30-day and 14-day readmission rates were 33.4% and 22.1%, respectively. 63 Readmissions were highest for the 18-to 30-year-old patients and for the publicly insured patients.…”

“…Sobota et al reported that transfused pediatric patients with crisis were readmitted less frequently to the hospital than otherwise. 65 The combination of NO and blood transfusion/hydration in the prodromal phase would restore perfusion and prevent or minimize damage because of hypoxia, the addition of anti-inflammatories would prevent or minimize damage because of inflammation, and, most importantly, aggressive management of pain may prevent central sensitization and "rewiring" of the brain.…”

“…Sobota et al identified 4762 patients with 12 104 qualifying hospitalizations of which 2074 hospitalizations (17%) were readmissions for sickle cell crisis within 30 days after discharge. 65 Risk markers for readmission included older children, pain, and treatment with steroids.Approximately 10% of children and ϳ 50% of adults with SCD continue to have pain between painful episodes. The severity and duration of each pain event between crises vary among persons.…”

Variation in Occult Injury Screening for Children With Suspected Abuse in Selected US Children’s Hospitals

“…Various peerreviewed publications have used PHIS to examine variation in care. [33][34][35][36][37][38] We used data from 40 hospitals located in 24 states and the District of Columbia, which contributed inpatient data for at least a 3-year portion of the study period (January 1, 1999-December 31, 2009). Only inpatient cases that contained procedure and/or billing codes were included because these codes provide information about the type and timing of radiologic studies.…”