Trends in Hospitalizations and Resource Utilization for Pediatric Pertussis

Abstract

BACKGROUND AND OBJECTIVE Pertussis is a serious and preventable childhood illness often necessitating hospitalization. The objective was to describe national trends in pediatric pertussis hospitalizations and resource utilization and factors associated with increased length of stay (LOS). METHODS This was a cross-sectional analysis of the 1997 to 2009 Healthcare Cost and Utilization Project Kids’ Inpatient Databases. We examined pediatric hospitalizations of children (0–18 years) with a diagnosis of pertussis. Primary outcomes were hospitalizations, LOS, and charges. Weighted linear regression was used to evaluate trends in resource utilization. Multivariate logistic regression was used to determine factors associated with prolonged LOS. RESULTS Infants 0 to 6 months old accounted for nearly 90% of pediatric pertussis hospitalizations. Hospitalizations in public payers increased from 50% in 1997 to 67.4% in 2009 (P < .01). Among children with complex chronic conditions (CCCs), pertussis hospitalizations increased from 9.4% in 1997 to 16.8% in 2009 (P < .01). Mean LOS for pediatric pertussis hospitalizations decreased from 5.40 days in 1997 to 5.28 days in 2009 (P < .01), whereas those for children with CCCs increased from 8.86 days in 1997 to 9.25 days in 2009 (P < .01). Mean adjusted charges for pediatric pertussis hospitalizations rose from $14 520 in 1997 to $22 278 in 2009 (P < .01). For all study years, neonates and children with CCCs had greater odds of prolonged LOS. CONCLUSIONS Young infants and publicly insured patients account for a disproportionate number of pertussis-related hospitalizations. Patients with CCCs are increasingly contributing to hospitalizations and resource utilization attributable to pertussis. As new vaccine recommendations are implemented, targeted interventions are warranted to increase preventive efforts in these vulnerable populations.

Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

“…18 A cross sectional study on healthcare utilization after a respiratory transmittable disease outbreak reported a trend of increased medical resource use and hospitalization for publicly insured patients. 19 It is hypothesized that the trend of increased use of emergency services, particularly among young pediatric patients, is associated with the national health insurance service that covers all residents in Korea.…”

Severe Pertussis in Childhood: Update and Controversy - Systematic Review

“…Ad. Lutz 38 Brazil2010 Manual of laboratory diagnosisLaboratory diagnosisDescribes standards, routines and recommendations by the national reference laboratory Reish U 39 Germany2001 Experimental study113 Laboratory diagnosisRT-PCR technique showed high specificity and high predictive value Lopez MA 48 USA2014 Cohort1.012 Severe pertussisNeonates and children with chronic diseases are the most vulnerable groups, requiring hospitalizationSVS: Secretariat of Health Surveillance; MS: Ministry of Health; PCR: polymerase chain reaction; RT-PCR: real-time polymerase chain reaction.…”

“…In addition to specific antibiotic therapy, severe cases of pertussis require additional approaches to advanced life support to minimize complications 47 48 Hospitalization is determined by the risk of serious progression, and newborns and young infants should be considered as patients with pulmonary, muscular or neurological disease, in which complications are more frequent 6 8 , 25 , 29 , 47 , 48 Adequatehydration is essential for the fluidification of respiratory secretions and maintenance of blood volume 12…”

“…, 48 Hospitalization is determined by the risk of serious progression, and newborns and young infants should be considered as patients with pulmonary, muscular or neurological disease, in which complications are more frequent 6 8 , 25 , 29 , 47 , 48 Adequatehydration is essential for the fluidification of respiratory secretions and maintenance of blood volume 12 48 Oxygentherapy is more frequently needed due to apnea, respiratory distress from pneumonia, intercurrent viral and bacterial infections, and pulmonary hypertension, being recommended in paroxysms and cyanosis crises 8 …”

“…, 8 , 25 , 29 , 47 , 48 Adequatehydration is essential for the fluidification of respiratory secretions and maintenance of blood volume 12 48 Oxygentherapy is more frequently needed due to apnea, respiratory distress from pneumonia, intercurrent viral and bacterial infections, and pulmonary hypertension, being recommended in paroxysms and cyanosis crises 8 12 , 47 , 48 Infantswhose fatigue results in hypercapnia are indicated for mechanical ventilation 6 …”