Readmission Diagnoses After Pediatric Severe Sepsis Hospitalization

Abstract

Objectives: Severe sepsis is a significant cause of healthcare use and morbidity among pediatric patients, but little is known about readmission diagnoses. We sought to determine the most common readmission diagnoses after pediatric severe sepsis, the extent to which post-sepsis readmissions may be potentially preventable, and whether patterns of readmission diagnoses differ compared with readmissions after other common acute medical hospitalizations.

Design: Observational cohort study.

Setting: National Readmission Database (2013-2014), including all-payer hospitalizations from 22 states.

Patients: Four-thousand five-hundred twenty-eight pediatric severe sepsis hospitalizations, matched by age, gender, comorbidities, and length of stay to 4,528 pediatric hospitalizations for other common acute medical conditions.

Interventions: None.

Measurements and main results: We compared rates of 30-day all cause, diagnosis-specific, and potentially preventable hospital readmissions using McNemar's chi-square tests for paired data. Among 5,841 eligible pediatric severe sepsis hospitalizations with live discharge, 4,528 (77.5%) were matched 1:1 to 4,528 pediatric hospitalizations for other acute medical conditions. Of 4,528 matched sepsis hospitalizations, 851 (18.8% [95% CI, 16.0-18.2]) were rehospitalized within 30 days, compared with 775 (17.1% [95% CI, 17.1-20.0]) of matched hospitalizations for other causes (p = 0.02). The most common readmission diagnoses were chemotherapy, device complications, and sepsis, all of which were several-fold higher after sepsis versus after matched nonsepsis hospitalization. Only 11.5% of readmissions were for ambulatory care sensitive conditions compared with 23% of rehospitalizations after common acute medical conditions.

Conclusions: More than one in six children surviving severe sepsis were rehospitalized within 30 days, most commonly for maintenance chemotherapy, medical device complications, or recurrent sepsis. Only a small proportion of readmissions were for ambulatory care sensitive conditions.

Figure 1:

Identification and Matching of the Severe Sepsis and Acute Medical Condition Cohorts Legend: Severe sepsis was identified in 0.75% of non-neonatal, non-pregnancy related pediatric hospitalizations of the Nationwide Readmissions Database in 2013-2014.

Figure 2:

Total and Potentially Preventable 30-day Readmissions Among Survivors of Severe Sepsis and Matched Hospitalizations for Acute Medical Conditions Legend: Potentially preventable readmissions include asthma, bacterial pneumonia, gastroenteritis, dehydration, uncontrolled diabetes/diabetic short-term complications, and perforated appendicitis.