RESUMO
OBJECTIVE: To evaluate trends in procedures used to treat children hospitalized in the US with empyema during a period that included the release of guidelines endorsing chest tube placement as an acceptable first-line alternative to video-assisted thoracoscopic surgery. STUDY DESIGN: We used National Inpatient Samples to describe empyema-related discharges of children ages 0-17 years during 2008-2014. We evaluated trends using inverse variance weighted linear regression and characterized treatment failure using multivariable logistic regression to identify factors associated with having more than 1 procedure. RESULTS: Empyema-related discharges declined from 3 in 100 000 children to 2 in 100 000 during 2008-2014 (P = .04, linear trend). There was no significant change in the proportion of discharges having 1 procedure (66.1% to 64.1%) or in the proportion having 2 or more procedures (22.1% to 21.6%). The proportion coded for video-assisted thoracoscopic surgery as the only procedure declined (41.4% to 36.2%; P = .03), and the proportions coded for 1 chest tube (14.6% to 20.9%; P = .04) and 2 chest tube procedures (0.9% to 3.5%; P < .01) both increased. The median length of stay for empyema-related discharges remained unchanged (9.3 days to 9.8 days; P = .053). Having more than 1 procedure was associated with continuous mechanical ventilation (adjusted OR, 2.7; 95% CI, 1.8-4.1) but not with age, sex, payer, chronic conditions, transfer admission, hospital size, or census region. CONCLUSIONS: The use of video-assisted thoracoscopic surgery to treat children in the US hospitalized with empyema seems to be decreasing without associated increases in length of stay or need for additional drainage procedures.
Assuntos
Empiema Pleural/cirurgia , Hospitalização/estatística & dados numéricos , Tempo de Internação/tendências , Cirurgia Torácica Vídeoassistida/tendências , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Gerenciamento Clínico , Drenagem/métodos , Drenagem/estatística & dados numéricos , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Modelos Logísticos , Masculino , Análise Multivariada , Alta do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVES: To evaluate hospitalizations at nonfederal facilities for lower respiratory tract infection (LRTI) in American Indian/Alaska Native (AI/AN) children and to compare associated rates and risk factors in AI/AN children and white children. STUDY DESIGN: We used Kids' Inpatient Database samples from 1997-2012 to identify discharges in non-Hispanic AI/AN and white children ages <5 years with a principal or secondary diagnosis code indicating LRTI. To address systematic underreporting and misclassification of race in administrative databases, population rates were estimated by deriving race- and year-specific denominators from hospital births. RESULTS: During the study period, LRTI-associated discharge rates (per 1000) declined for white children (from 14.8 to 10.9; P < .001 for trend). For AI/AN children, rates varied widely by census region and were highest in the West, where they ranged from 38.6 in 1997 to 26.7 in 2012 (P = .35 for trend). Discharges in AI/AN children were associated with low household income, Medicaid insurance, and rural residence. In a case-cohort analysis of infants hospitalized with LRTI in 2012, discharge rates were higher for AI/AN infants than for white infants only in the West (72.8 vs 22.2; aOR, 2.5; 95% CI, 1.8-3.4). CONCLUSIONS: Among young children who use nonfederal hospitals, LRTI-associated hospitalizations occur at substantially higher rates for AI/AN children than for white children. These hospitalizations occur at rates that are particularly high for AI/AN infants in the West, where rates are comparable with those reported for Indian Health Service enrollees.
Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Hospitalização/tendências , Indígenas Norte-Americanos , Infecções Respiratórias/etnologia , Pré-Escolar , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População BrancaRESUMO
OBJECTIVES: To describe the clinical spectrum and frequency of acute care revisits after tonsillectomy in a population-based sample from a single state in the US. STUDY DESIGN: We used California state discharge databases from 2009 to 2011 to retrospectively identify retrospectively routine tonsillectomy discharges in residents <25 years of age and to establish record linkage to revisits within 30 days at ambulatory surgery, inpatient, and emergency department facilities statewide. Percentages and descriptive statistics were sample-weighted, and revisit rates were adjusted for demographic factors, expected payer, chronic conditions, surgical indication, facility type, and clustering. RESULTS: Records were available for 35â085 index tonsillectomies, most of which were performed at hospital-owned ambulatory and inpatient facilities. There were 4944 associated revisits: 3761 (75.9%) treat-and-release emergency room visits, 816 (17.1%) inpatient admissions, and 367 (7.0%) ambulatory surgery visits. Most revisits (3225 [67.7%]) were unrelated to bleeding; these typically occurred early (mode, day 2) and were commonly associated with diagnosis codes indicating pain, nausea/vomiting, or dehydration. Crude all-cause revisit and readmission rates were 10.5% and 2.1%, respectively. Adjusted all-cause revisit rates (range, 8.6%-24.5%) were lowest in young children, increased in adolescents, and peaked in young adults. Adjusted bleeding-related revisit rates increased abruptly in adolescents and reached 13.9% in males (6.8% in females, P < .001) ages 20-24 years. CONCLUSIONS: Acute care revisits after tonsillectomy performed at predominantly hospital-owned facilities in California are common and strongly age-related. Most revisits are early treat-and-release outpatient encounters, and these are usually associated with potentially preventable problems such as pain, nausea and vomiting, and dehydration.