Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 5;6(9):e2330774.
doi: 10.1001/jamanetworkopen.2023.30774.

Readmission Rates After Acute Respiratory Distress Syndrome in Children

Garrett Keim  1   2   3 , Jesse Y Hsu  4 , Neethi P Pinto  1   2 , Megan L McSherry  1 , Annie Laurie Gula  1 , Jason D Christie  4   5 , Nadir Yehya  1   2   3
Affiliations

Readmission Rates After Acute Respiratory Distress Syndrome in Children

Garrett Keim et al. JAMA Netw Open. .

Abstract

Importance: An increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown.

Objective: To determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission.

Design, setting, and participants: This retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to <18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023.

Exposures: Complex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS.

Main outcomes and measures: The primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission.

Results: One-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47).

Conclusions and relevance: In this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Keim reported receiving nonfinancial support from Timpel Medical, which loaned an electrical impedance tomography device for research to his institution outside the submitted work. Dr Hsu reported receiving personal fees from the National Kidney Foundation Statistics for serving as an editor of American Journal of Kidney Diseases, the Public Library of Science for serving as statistical advisor for PLoS ONE, and the American Medical Association for serving as statistical reviewer of JAMA Network Open outside the submitted work. Dr Christie reported receiving grants from CFF outside the submitted work. Dr Yehya reported receiving personal fees from AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Enrollment Flowchart
ARDS indicates acute respiratory distress syndrome; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.
Figure 2.
Figure 2.. Kaplan-Meier Survival Curve Comparing Readmission for Children Receiving Mechanical Ventilation With Those With Algorithm-Identified Acute Respiratory Distress Syndrome (ARDS)
Figure 3.
Figure 3.. Kaplan-Meier Survival Curves of Unadjusted Readmission by Primary Exposures of Interest
Graphs show probability of readmission after algorithmic-identified acute respiratory distress syndrome according to type of complex chronic condition (CCC) present at discharge (A), whether new tracheostomy was performed during hospitalization (B), and hospitalization length of stay (LOS) (C).
See this image and copyright information in PMC

Comment in

References

    1. Batista NOW, de Rezende Coelho MC, Trugilho SM, Pinasco GC, de Sousa Santos EF, Ramos-Silva V. Clinical-epidemiological profile of hospitalised patients in paediatric intensive care unit. J Hum Growth Dev. 2015;25(2):187-193. doi:10.7322/jhgd.103014 - DOI
    1. Killien EY, Keller MR, Watson RS, Hartman ME. Epidemiology of intensive care admissions for children in the US from 2001 to 2019. JAMA Pediatr. 2023;177(5):506-515. doi:10.1001/jamapediatrics.2023.0184 - DOI - PMC - PubMed
    1. Watson RS, Hartman ME. Epidemiology of critical illness. In: Wheeler DS, Wong HR, Shanley TP, eds. Pediatric Critical Care Medicine. Springer; 2014:125-131. doi:10.1007/978-1-4471-6362-6_13 - DOI
    1. Herridge MS, Tansey CM, Matté A, et al. ; Canadian Critical Care Trials Group . Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293-1304. doi:10.1056/NEJMoa1011802 - DOI - PubMed
    1. Herridge MS, Cheung AM, Tansey CM, et al. ; Canadian Critical Care Trials Group . One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683-693. doi:10.1056/NEJMoa022450 - DOI - PubMed

Publication types