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Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy
Author(s) -
Russell Christopher J.,
Thurm Cary,
Hall Matt,
Simon Tamara D.,
Neely Michael N.,
Berry Jay G.
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23938
Subject(s) - medicine , interquartile range , tracheotomy , hazard ratio , retrospective cohort study , pediatrics , proportional hazards model , emergency medicine , surgery , confidence interval
Objective Identify characteristics associated with hospital readmission due to bacterial respiratory tract infections (bRTI) after tracheotomy. Study design Retrospective study of 8009 children 0‐17 years undergoing tracheotomy from 2007 to 2013 at 48 children's hospitals in the Pediatric Health Information System database. The primary outcome was first hospital admission after tracheotomy for bRTI (ie, primary diagnosis of bRTI or a primary diagnosis of bRTI symptom and secondary diagnosis of bRTI). We used Cox‐proportional hazard modeling to assess associations between patient demographic and clinical characteristics and bRTI hospital readmission. Results Median age at tracheotomy admission was 5 months (interquartile range [IQR]: 1‐50 months). Thirty‐six percent ( n = 2899) had at least one bRTI admission. Median time‐to‐readmission for bRTI was 275 days (IQR: 141‐530). Factors independently associated with increased risk for bRTI readmission were younger age (eg, age < 30 days vs 13‐17 years [aHR 1.32; 95%CI: 1.11‐1.58]), Hispanic race/ethnicity (vs non‐Hispanic White; aHR: 1.34; 95%CI: 1.20‐1.50), government insurance (vs private; aHR 1.21; 95%CI: 1.10‐1.33), >2 complex chronic conditions (vs zero; aHR 1.96; 95%CI: 1.34‐2.86) and discharge to home (vs post‐acute care setting; aHR 1.19; 95%CI: 1.08‐1.32). Trauma diagnosis at tracheotomy (aHR 0.83; 95%CI: 0.69‐1) and ventilator dependency (aHR 0.88; 95%CI: 0.81‐0.97) were associated with decreased risk. Conclusions Young, Hispanic children with multiple complex chronic conditions who use Medicaid insurance and are not discharged to post‐acute care are at the highest risk for hospital readmission for bRTI post‐tracheotomy. Future research should investigate strategies to mitigate this risk for these children.