Variation in Dexamethasone Dosing and Use Outcomes for Inpatient Croup.

2021

2021 Dec 01

2154-1671

<p><strong>OBJECTIVES: </strong>Evaluate the association between dexamethasone dosing and outcomes for children hospitalized with croup.</p>

<p><strong>METHODS: </strong>This study was nested within a multisite prospective cohort study of children aged 6 months to 6 years admitted to 1 of 5 US children's hospitals between July 2014 and June /2016. Multivariable linear and logistic mixed-effects regression models were used to examine the association between the number of dexamethasone doses (1 vs &gt;1) and outcomes (length of stay [LOS], cost, and 30-day same-cause reuse). All multivariable analyses included a site-specific random effect to account for clustering within hospital and were adjusted for age, sex, race and ethnicity, presenting severity, medical complexity, insurance, caregiver education, and hospital. In cost analyses, we controlled for LOS.</p>

<p><strong>RESULTS: </strong>Among 234 children hospitalized with croup, patient characteristics did not differ by number of doses. The proportion receiving &gt;1 dose varied by hospital (range 27.9%-57.1%). In adjusted analyses, &gt;1 dose was not associated with same-cause reuse (odds ratio 0.87 [95% confidence interval (CI): 0.26 to 2.95]) but was associated with 45% longer LOS (relative risk = 1.45 [95% CI: 1.30 to 1.62]). When we controlled for LOS, &gt;1 dose was not associated with differential cost ($-31.2 [95% CI $-424.4 to $362.0]). Eighty-two (35%) children received dexamethasone before presentation.</p>

<p><strong>CONCLUSIONS: </strong>We found significant interhospital variation in dexamethasone dosing and LOS. When we controlled for severity on presentation, &gt;1 dexamethasone dose was associated with longer LOS but not reuse. Although incomplete adjustment for severity is one possible explanation, some providers may routinely keep children hospitalized to administer multiple dexamethasone doses.</p>

10.1542/hpeds.2021-005854

Hosp Pediatr

34846064

Costs and Reimbursements for Mental Health Hospitalizations at Children's Hospitals.

2020

2020 May 21

1553-5606

<p>The financial impact of the rising number of pediatric mental health hospitalizations is unknown. Therefore, this study assessed costs, reimbursements, and net profits or losses for 111,705 mental health and non-mental health medical hospitalizations in children's hospitals with use of the Pediatric Health Information System and Revenue Management Program. Average financial margins were calculated as (reimbursement per day) - (cost per day), and they were lowest for mental health hospitalizations ($136/day), next lowest for suicide attempt ($518/day), and highest for other medical hospitalizations ($611/day). For 10 of 17 hospitals, margin per day for mental health hospitalizations was lower than margin per day for other medical hospitalizations. For these 10 hospitals, the total net loss for inpatient and observation status mental health hospitalizations, compared with other medical hospitalizations, was $27 million (median, $2.2 million per hospital). Financial margins were usually lower for mental health vs non-mental health medical hospitalizations.</p>

10.12788/jhm.3411

J Hosp Med

32496188

Hospitalization for Suicide Ideation or Attempt: 2008-2015.

2018

pii: e20172426.

2018 Jun

1098-4275

<p><strong>OBJECTIVES: </strong>Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children's hospitals from 2008 to 2015.</p>

<p><strong>METHODS: </strong>We used retrospective analysis of administrative billing data from the Pediatric Health Information System database.</p>

<p><strong>RESULTS: </strong>There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall.</p>

<p><strong>CONCLUSIONS: </strong>Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems.</p>

10.1542/peds.2017-2426

Pediatrics

29769243