Age- and Diagnosis-Based Trends for Unplanned Pediatric Rehospitalizations in the United States

Abstract

Background and objectives: Hospital readmission rate helps to highlight the effectiveness of post-discharge care. There remains a paucity of plausible age-based categorization especially for ages below one year for hospital readmission rates.

Methods: Data from the 2017 Healthcare Cost and Utilization Project National Readmissions Database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. Results: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant diagnoses leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages one to four years, dehydration, asthma and bronchiolitis were negative predictors of unplanned readmission. Conclusions: Thirty-day unplanned readmissions remain a problem leading to billions of taxpayer dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

Keywords: asthma; cancer; depression; diabetes mellitus; inflammatory bowel disease; pediatric hospital medicine; pediatric rehospitalizations.

Figure 1. Forest plot analysis of pertinent diagnosis associated with 30-day readmission: Age group <1 year

Abbreviations: GI: gastrointestinal; UTI: urinary tract infection

Figure 2. Forest plot analysis of pertinent diagnosis associated with 30-day readmission: Age group 1-4 years

Abbreviations: GI: Gastrointestinal; UTI: urinary tract infection; IBD: Inflammatory bowel disease

Figure 3. Forest plot analysis of pertinent diagnosis associated with 30-day readmission: Age group 5-12 years

Abbreviations: IBD: Inflammatory bowel disease; UTI: Urinary tract infection

Figure 4. Forest plot analysis of pertinent diagnosis associated with 30-day readmission: Age group 13 years and above

Abbreviations: IBD: Inflammatory bowel disease; GI: Gastrointestinal; UTI: Urinary tract infection