ICU admission, multispecialty care, other factors extend pediatric neurology hospital stay
Several factors, including pediatric ICU admission and multispecialty care, increased length of stay and costs at pediatric neurology hospitals, according to results of a retrospective review published in Journal of Child Neurology.
“Pediatric neurology admissions account for a large proportion of children’s hospital admissions and have a 30-day readmission rate of 6.9%,” Annie Roliz, MD, from the division of child neurology in the department of pediatrics at Cohen Children’s Medical Center in New York, and colleagues wrote. “Little is known about the factors influencing length of stay or the relationship between length of stay and readmission in pediatric neurology. Although short length of stay is associated with readmission for some adult conditions, decreased length of stay does not increase pediatric readmission.”
The researchers aimed to elucidate patterns related to inpatient length of stay, pinpoint factors associated with prolonged length of stay and assess the link between length of stay and readmission in pediatric neurology. They included data from patients aged younger than 19 years who were admitted to a tertiary care children’s hospital with a principal neurologic diagnosis between January 2017 and July 2019. They excluded from the analysis patients with scheduled admissions and hospital admissions that lasted longer than 30 days.
In addition to length of stay, the researchers also obtained data on demographic characteristics, principal discharge diagnosis, multispecialty care, use of multiple antiseizure medications, inpatient hospital costs and pediatric ICU admission for unplanned admissions and 7- and 30-day readmissions. They obtained data from 1,579 unplanned admissions.
Seizure (n = 942) represented the most common reason for admission, followed by headache (n = 161), other neurologic diagnosis (n = 121) and psychiatric disorders/functional neurologic disorder (n = 60). Roliz and colleagues reported an average length of stay of 2.8±5 days for unplanned admissions, 4.5±7.4 days for 7-day readmissions and 5.2±7.5 days for 30-day readmissions among children admitted to the hospital for a neurologic condition. Average inpatient hospital costs totaled $44,075±56,976 for unplanned admissions, $60,361±71,427 for 7-day readmissions, and $55,434±56,442 for 30-day readmissions, according to the researchers. They noted a correlation between prolonged length of stay and increased hospital costs and pediatric ICU admission, multispecialty care, 7- and 30-day readmission, multiple antiseizure medications and psychiatric disorders/functional neurologic disorders.
According to study co-author Sanjeev Kothare, MD, director of the division of pediatric neurology at Cohen Children’s Medical Center in New York, these data provide “a benchmark that can be used by other centers to compare their length of stay with ours.”
The researchers also offered a suggested direction for future research in this area.
“Future research can be done with multiple centers to further evaluate the relationships between length of stay and readmission and initiate targeted discharge-related interventions for high-risk patients,” they wrote.