Open AccessEncounters From Device Complications Among Children With Medical Complexity
Author(s) -
Allison Nackers,
Mary L. Ehlenbach,
Michelle M. Kelly,
Nicole E. Werner,
Gemma Warner,
Ryan J. Coller
Publication year - 2019
Publication title -
hospital pediatrics
Language(s) - English
Resource type - Journals
eISSN - 2154-1663
pISSN - 2154-1671
DOI - 10.1542/hpeds.2018-0103
Subject(s) - medicine , confidence interval , odds ratio , emergency department , logistic regression , emergency medicine , retrospective cohort study , central venous catheter , inter rater reliability , feeding tube , pediatrics , catheter , surgery , psychology , developmental psychology , rating scale , psychiatry
OBJECTIVES: Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. Our objective was to identify predictors of device-complicated ED visits and hospitalizations. METHODS: This single-center retrospective cohort study included patients referred to a Pediatric Complex Care Program between April 1, 2014, and April 30, 2016, assisted by at least 1 medical device. Hospitalizations and ED visits in the year before enrollment were rated for likelihood for being due to device complications. Interrater reliability among 3 independent reviewers was assessed. Bivariate followed by multivariate logistic regression clustered by patient helped us identify associations between demographic, clinical, and device characteristics associated with device-complicated ED or hospital encounters. RESULTS: Interrater reliability was high (κ = 0.92). Among 98 CMC, device-complicated encounters represented 17% of 258 hospitalizations and 31% of 228 ED visits. Complications of 3 devices (central venous catheters, enteral tubes, and tracheostomy tubes) accounted for 13% of overall hospitalizations and 28% of overall ED visits. Central venous catheter presence (adjusted odds ratio [aOR] 3.2 [95% confidence interval (CI) 1.1–9.5]) was associated with device-complicated ED visits. Gastrojejunostomy/jejunostomy tube presence (aOR 3.3 [95% CI 1.5–7.5]) or tracheostomies with (aOR 8.1 [95% CI 2.3–28.5]) or without (aOR 4.5 [95% CI 1.7–7.5]) ventilator use was associated with device-complicated hospitalizations. Clinical variables were poor predictors of device-complicated encounters. CONCLUSIONS: Device-complicated ED visits and hospitalizations comprised a substantial proportion of total hospital and ED use. Developing interventions to prevent device complications may be a promising strategy to reduce overall CMC use.