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Pediatric acute sinusitis: Predictors of increased resource utilization
Author(s) -
Dugar Deepak R.,
Lander Lina,
MahalingamDhingra Aditya,
Shah Rahul K.
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21152
Subject(s) - medicine , sinusitis , medicaid , diagnosis code , pediatrics , concomitant , retrospective cohort study , emergency medicine , health care , surgery , population , environmental health , economics , economic growth
Objective: To determine variations in resource utilization in the management of pediatric acute sinusitis. Study Design: Retrospective analysis of a publicly available national dataset. Methods: The Kids' Inpatient Database 2006 was analyzed using ICD‐9 codes for acute sinusitis. Results: A total of 8,381 patients (55% male, mean age 8.5 years [SE = 0.2]) were admitted with acute sinusitis. Mean total charges was $20,062 (SE = 1,159.1). Mean length of stay was 4.2 days (SE = 0.12), with 4.8 diagnoses (SE = 0.06) and 0.85 procedures (SE = 0.06). Thirty‐six percent had concomitant respiratory diseases, 11% otitis media, and 8% orbital symptoms. A total of 703 patients underwent operations on the upper aerodigestive tract (534 were nasal sinusectomies); 582 patients underwent lumbar puncture and 162 underwent orbital surgery. The primary payer was private insurance in 50% and Medicaid in 41%. Predictors of increased total charges were male gender ( P =.028), being a teaching hospital ( P < .0001), metropolitan patient location ( P < .0001), hospitals in the western region ( P < .0001), admission source from another hospital ( P < .0001), and discharge status to another inpatient hospital or home healthcare ( P < .0001). There is a large geographic variation in resource utilization (range = $5,837 [Arkansas] to $48,327 [California]). Race, primary payer, admission type, and urgency were not significant predictors of increased resource utilization. Conclusions: Despite being a common diagnosis, there exists a large national variation in management of acute pediatric sinusitis. Predictors of increased resource utilization included male gender, teaching hospital status, metropolitan patient location, western hospital region, admission source, and discharge status. Knowledge of these variables may allow interventions and potentially facilitate benchmarking to reduce the economic burden of this entity while ensuring optimal outcomes. Laryngoscope, 2010