Length Of Stay For Children Research Articles

95 Characteristics and Length of Stay in Children With Bronchiolitis With and Without Intravenous Hydration

95 Characteristics and Length of Stay in Children With Bronchiolitis With and Without Intravenous Hydration

Factors Affecting Length of Stay for Children Hospitalized After Pediatric Surgical Procedures.

Understanding the postoperative length of stay (LOS) by surgical procedure is important for hospital medicine clinicians involved in surgical co-management. We assessed variation in postoperative LOS for children after elective surgical procedures and risk factors for prolonged LOS. This study is a retrospective analysis of pediatric patients undergoing elective surgical procedures between January 1, 2018 and October 1, 2021 with postoperative hospitalization for recovery at a freestanding children's hospital. The postoperative LOS (number of days) was compared across types of surgery and by the number of chronic conditions (assessed with the Agency for Healthcare Research and Quality Condition Indicator system) using multivariable quantile regression. The median (interquartile range) LOS across all 347 types of surgical procedures combined was 2 (interquartile range 1-4). Surgical procedures (n = 85) with a median LOS between 3.0 and <5.0 days (eg, spinal fusion, Chiari decompression) accounted for 20.9% of all hospitalizations (N = 12 139) and 23.1% of all postoperative bed days. Procedures (n = 46) with a median LOS of ≥5.0 days (eg, femoral osteotomy, bladder reconstruction) accounted for 15.0% and 46.8% of all hospitalizations and bed days, respectively. After controlling for the type of procedure, having ≥4 (versus none) chronic conditions was significantly associated with experiencing a prolonged LOS (90th percentile: 5.2 days); patients with 4 to 6, versus no, chronic conditions stayed a median of 1.4 (95% confidence interval [CI] 0.7-2.2) days longer, those with 7 to 9 chronic conditions stayed a median of 1.9 (95% CI 1.0-2.7) days longer, and those with ≥10 chronic conditions stayed a median of 4.0 (95% CI 3.3-4.7) days longer. Hospital medicine clinicians can use the type of surgery in combination with the number of chronic conditions to estimate postoperative LOS after elective surgical procedures in children.

Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion

BackgroundIngestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity.MethodsThe Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 – January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data.ResultsDuring the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1–3 days).ConclusionsThe ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.

Preoperative Biopsychosocial Assessment and Length of Stay in Orthopaedic Surgery Admissions of Youth with Cerebral Palsy

Caregivers of children with cerebral palsy (CP) experience stress surrounding orthopaedic surgery related to their child's pain and recovery needs. Social determinants of health can affect the severity of this stress and hinder health care delivery. A preoperative biopsychosocial assessment (BPSA) can identify risk factors and assist in alleviating psychosocial risk. This study examined the relationship between the completion of a BPSA, hospital length of stay (LOS), and 30-day readmission rates for children with CP who underwent hip reconstruction (HR) or posterior spinal fusion (PSF). Outcomes were compared with a matched group who did not have a preoperative BPSA. The BPSA involved meeting with a social worker to discuss support systems, financial needs, transportation, equipment, housing, and other services. A total of 92 children (28 HR pairs, 18 PSF pairs) were identified. Wilcoxon analysis was statistically significant (p = 0.000228) for shorter LOS in children who underwent PSF with preoperative BPSA (median = 7.0 days) vs. without (median = 12.5 days). Multivariate analysis showed that a BPSA, a lower Gross Motor Function Classification System level, and fewer comorbidities were associated with a shorter LOS after both PSF and HR (p < 0.05). Identifying and addressing the psychosocial needs of patients and caregivers prior to surgery can lead to more timely discharge postoperatively.

Association of nutritional status with clinical outcomes of critically ill pediatric patients with complex chronic conditions

There is a high prevalence of children with complex chronic conditions (CCCs) in pediatric intensive care units (PICUs). However, information on the nutritional status (NS) of this specific population is limited. This study aimed to evaluate the NS of critically ill pediatric patients with CCCs and to relate it to clinical outcomes. A retrospective cohort study of children admitted to a PICU over a 4-year period. We classified NS according to body mass index-for-age (BMI/A) and height-for-age (H/A) z-scores, using the World Health Organization (WHO) growth curves as a reference. We recorded the presence of CCC according to the definition proposed by Feudtner etal. Severity on admission was measured using the Pediatric Index of Mortality 2 (PIM2). We assessed the following outcomes: mortality, multiple organ dysfunction syndrome during PICU stay, and PICU length of stay (LOS). We included 1753 children in the study. Presence of CCC accounted for 49.8% (873) of the sample. Among children with CCCs, 61.7% (539) had appropriate weight, 19.8% (173) were underweight, and 18.4% (161) were overweight. H/A was considered inadequate in 32.2% (281) of patients with CCCs, a higher rate than in those without CCCs (25.3%; 132) (p<0.001). Regarding outcomes, underweight children had more organ dysfunctions and prolonged LOS. The association only remained for prolonged LOS when adjusting for confounders. Although underweight children had a higher PIM2-predicted risk of mortality, there was no significant difference in actual mortality between the three NS groups (p=0.200). The rates of nutritional inadequacies in patients with CCCs were high. Underweight was independently associated with prolonged LOS in children with CCC.

Severe liver injury affects the outcomes and length of hospital stay in children with community-acquired pneumonia.

The present study was undertaken to evaluate the association between liver injury and clinical parameters, outcomes and length of stay (LOS) in hospital in children with community-acquired pneumonia (CAP). Clinical data and laboratory indicators of 2,573 children with CAP were analyzed. The association between liver injury and clinical parameters, outcomes and LOS was then analyzed. Higher liver injury class was associated with higher incidence of severe CAP, comorbidities, hypoxia, requirement for mechanical ventilation, 30-day mortality and intensive care unit admission, and higher indicators of inflammation (C-reactive protein, procalcitonin and white blood cell count), longer LOS, faster respiratory rate and pulse rate, and lower age, serum albumin levels, monocyte and lymphocyte counts. Severe liver injury was identified as an independent factor for 30-day mortality and prolonged LOS in children with CAP. Higher liver injury class was associated with a lower cumulative survival rate (p=0.0004), and log-rank test for trend was used to demonstrate the association of each injury class with 30-day mortality (p=0.0002). Several parameters were associated with liver injury in children with CAP. Severe liver injury was found to be an independent factor for 30-day mortality and LOS in children with CAP.

Early combination therapy with immunoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syndrome in Children (MIS‐C) associated with COVID‐19: A retrospective cohort analysis from 28 U.S. Hospitals

ObjectivesSuggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS‐C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The primary objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS) in patients with MIS‐C associated with Coronavirus Disease 2019 (COVID‐19).Study DesignThis was a retrospective study on 356 hospitalized patients with MIS‐C from March 2020 to September 2021 (28 sites in the United States) in the Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID‐19 Registry. The effect of IVIG and steroids initiated in the first 2 days of admission, alone or in combination, on LOS was analyzed. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site.ResultsThe median age of the study population was 8.8 (Interquartile range (IQR) 4.0, 13) years. 247/356 (69%) patients required intensive care unit (ICU) admission during hospitalization. Overall hospital mortality was 2% (7/356). Of the total patients, 153 (43%) received IVIG and steroids, 33 (9%) received IVIG only, 43 (12%) received steroids only, and 127 (36%) received neither within 2 days of admission. After adjustment of confounders, only combination therapy showed a significant decrease of ICU LOS by 1.6 days compared to no therapy (exponentiated coefficient 0.71 [95% confidence interval 0.51, 0.97, p = 0.03]). No significant difference was observed in hospital LOS or the secondary outcome variable of the normalization of inflammatory mediators by Day 3.ConclusionsCombination therapy with IVIG and steroids initiated in the first 2 days of admission favorably impacts ICU but not the overall hospital LOS in children with MIS‐C.

A Prospective, Cohort Study of the Effect of Acute and Chronic Malnutrition on Length of Stay in Children Having Surgery in Rwanda.

Malnutrition is common in pediatric surgical patients, but there are little data from low-income countries that estimate the association of malnutrition with surgical outcomes. We aimed to determine the prevalence of malnutrition and its association with length of stay (LOS) among pediatric surgical patients in Kigali, Rwanda. We conducted a prospective observational cohort study. We enrolled surgical patients between 1 month and 15 years of age. We measured the association of acute malnutrition (wasting) and chronic malnutrition (stunting) with postoperative LOS using log-gamma regression to account for the skewed LOS distribution. Adjustment was made for sex, age, elective versus emergency surgery, household income, and American Society of Anesthesiologists (ASA) classification. Of 593 children, 124 children (21.2%) had acute malnutrition (wasting) with 39 (6.6%) severely wasted. A total of 160 (26.9%) children had chronic malnutrition (stunting), with 81 (13.7%) severely stunted. Median (interquartile range [IQR]) LOS after surgery was 2 (1-5) days for children with mild/no wasting, 6 (2.5-12.5) days for children with moderate wasting, and 6 (2-15) days with severe wasting. Median (IQR) LOS after surgery was 2 (1-6) days for children with mild/no stunting, 3 (1-3) days for children with moderate stunting, and 5 (2.3-11.8) days with severe stunting malnutrition. After adjustment for confounders, the moderate wasting was associated with increased LOS, with ratio of means (RoM), 1.6; 95% confidence interval [CI], 1.3-2.0; P < .0001. Severe wasting was not associated with increased LOS (RoM, 1.3; 95% CI, 0.9-1.7; P = .12). Severe, but not moderate, stunting was associated with increased LOS (RoM, 1.9; 1.5-2.4; P < .0001). Malnutrition is prevalent in >20% of children presenting for surgery and associated with increased LOS after surgery, even after accounting for individual and family-level confounders. Although some aspects of malnutrition may relate to the surgical condition, severe malnutrition may represent a modifiable social risk factor that could be targeted to improve postoperative outcomes and resource use. Severely stunted children should be identified as at risk of having delayed recovery after surgery.

Variation in the Number of Dexamethasone Doses in Croup

Variation in the Number of Dexamethasone Doses in Croup

Changing Evaluation and Management of Severe Orbital Infections

Research Article| October 01 2021 Changing Evaluation and Management of Severe Orbital Infections AAP Grand Rounds (2021) 46 (4): 46. https://doi.org/10.1542/gr.46-4-46 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Changing Evaluation and Management of Severe Orbital Infections. AAP Grand Rounds October 2021; 46 (4): 46. https://doi.org/10.1542/gr.46-4-46 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: magnetic resonance imaging, orbital cellulitis, cellulitis, periorbital cellulitis, adrenal corticosteroids, empirical antibiotic therapy, glucocorticoids, mineralocorticoids, saline solutions, sinusitis Source: Krueger C, Mahant S, Begum N, et al Changes in the management of severe orbital infections over seventeen years. Hosp Pediatr. 2021;11(6):613-621; doi:10.1542/hpeds.2020-001818Google Scholar Investigators from The Hospital for Sick Children and the University of Toronto, both in Toronto, Canada, conducted a retrospective study to compare management and outcomes among children hospitalized at their institution with severe orbital infections (including periorbital cellulitis, orbital cellulitis, and subperiosteal or orbital abscess) during 2 periods (2000–2005 and 2012–2016). Study participants were identified by ICD-9 and ICD-10 codes, Canadian version. The medical records of the identified children were reviewed, and data on demographics, antibiotic usage, use of adjuvant therapies (including intranasal corticosteroids and intranasal saline rinses), results of radiologic tests, length of stay (LOS), and complications were abstracted. Antibiotics were categorized as narrow or broad spectrum based on a standardized classification system. Differences in patient characteristics, management, and outcomes were assessed with t-tests or Mann-Whitney U tests for continuous data and chi-square of Fisher Exact tests for categorical data. There were 318 children identified with severe orbital infections, including 143 from 2000–2005 (Time Period 1) and 175 from 2012 2012–2016 (Time Period 2). The median age of study patients was 5.4 years, and 68.9% were male. Overall, the demographics of study participants from the 2 time periods were similar. Children with periorbital cellulitis were significantly younger than those diagnosed with orbital cellulitis (mean ages 4.0 and 6.4 years, respectively; P ≤0.01). Overall, a bacteriology etiology was identified in limited number of patients; the most common organisms isolated were Streptococcus anginosus (N = 21) and S aureus (N = 17). Among the 199 children (62.6%) for whom computerized tomography (CT) scans were obtained, 88% had sinusitis, 80% had orbital involvement, and 55% had orbital or subperiosteal abscess. The rate of CT use in patients during the 2 time periods were similar (60% in Time Period 1 and 65% in Time Period 2); disease severity based on CT findings also were similar. There was a significant increase in use of MRI in Time Period 2 compared to Time Period 1 (11% and 4%, respectively; P = 0.04). There also were significant increases in the number of intravenous antibiotics prescribed per patient in Time Period 2 (median value 3 vs 1 in Time Period 1; P ≤0.01), use of broad-spectrum antibiotics, use of intranasal corticosteroids (49% and 3%, respectively; P ≤0.01), and intranasal saline rinses (48% and 1%, respectively; P ≤0.01). LOS for children with periorbital cellulitis decreased for those hospitalized in Time Period 2 (median 45.3 hours vs 67.3 hours for those in Time Period 1; P = 0.01), but the LOS was similar for those with orbital cellulitis. Overall, severe complications occurred in 3.8% of study patients and included Potty’s puffy tumor (N = 8), intracranial extension of infection (N = 8), and cavernous sinus thrombosis (N = 3). The authors conclude that... You do not currently have access to this content.

Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta.

Coarctation of the aorta is a relatively common congenital heart disease occurring in 0.4-0.6 per 1000 live births with a low mortality rate. This is a retrospective study, with data abstracted from the Pediatric Health Information System database (PHIS). The study sample included pediatric patients less than or equal to 3months of age discharged from a PHIS participating hospital between January 1, 2004 and December 31, 2018 who underwent surgical repair of isolated COA. The primary outcome for the study was post-operative hospital length of stay (PH-LOS), and the secondary outcome was in-hospital mortality. Patient demographics, comorbidities, procedures, and outcomes were assessed for statistical differences between eras. A total of 5354 patients were included in the study. The study highlights an increasing trend in PH-LOS and NICU hospital length of stay (NICU-LOS) across the investigated eras. Prematurity (before 37weeks gestation) was an independent risk factor associated with both longer post-operative length of the stay and higher mortality. In addition, congenital anomalies, respiratory and abdominal surgeries have a significant impact on the post-operative hospital stay. In conclusion, this study is the largest published systematic assessment of PH-LOS in patients with isolated COA repair during infancy to date and identifies independent risk factors of increased PH-LOS.

Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

Background and Objectives:Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population.Methods:The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05.Results:A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386–2.673).Conclusion:Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.

Weekend Admission Is Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

Weekend Admission Is Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

Impact of Enhanced Care Coordination on Emergency Department and In-patient Hospital utilization and Hospital Length of Stay for Children with Medical Complexity

Impact of Enhanced Care Coordination on Emergency Department and In-patient Hospital utilization and Hospital Length of Stay for Children with Medical Complexity

Impact of Clinical, Laboratory and Fluid Therapy Variables on Hospital Length of Stay for Children with Acute Pancreatitis.

PurposeThere have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP.MethodsWe conducted a retrospective chart review of patients between ages of 0–18 years, who were admitted with AP at 2 institutions between 2013–2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS.ResultsNinety-two patients were included in the study. The mean age was 12 years (range, 7.6–17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49).ConclusionElevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

Comorbid Diseases Is a Predictor Length of Stay in Children with Severe Acute Malnutrition

Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in children in developing countries. Patient with SAM mostly hospitalized with comorbidity that reduce the time of recovery and longer the length of stay (LOS). The aim of this study is to determine the association between comorbid with longer LOS among children with SAM. This was a retrospective cohort study from 2017-2018 on children with SAM conducted in the pediatric care ward of Sanglah Denpasar General Hospital. Inclusion criteria was children aged 1 months to 18 years diagnosed with SAM and had complete data at the start of admission. Exclusion criteria was patient discharged against medical advice. 134 children with SAM were included and analyzed with appropriate statistical analysis. The median of LOS was 18 days, comorbid at admission found were infection (31.3%), non-infection (56.0%), both infection and non-infection (12.7%). HIV found as the most comorbid in SAM patient (21.3%) followed by malignancy (17.3%), congenital heart disease (14%), and pneumonia (12.7%). Multivariate analysis found that comorbid was a risk factor for longer LOS in hospitalized SAM patients. Comorbid increases the LOS by 3.23 times (95% CI 1.563-6.709) p value 0.002. Bivariate analysis found that infection as comorbid increase the LOS by 1.72 times (95% CI 1.171-2.524) p value 0.011. Conclusion that comorbid at admission was associated with longer LOS in hospitalized patient with SAM.

The Relationship Between Estimated Median Household Income and Critical Care Length of Stay in Children With Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is an important diagnosis in the pediatric intensive care unit (PICU) and is associated with significant morbidity. We hypothesized children with DKA living in poorer communities would have unfavorable outcomes while critically ill. This single-center retrospective study included children with DKA admitted to a PICU over a 27-month period. Patients were classified as low-income if they lived in a ZIP code where the median household income was estimated to be less than 200% of the federal poverty threshold, or $48 016 for a family of 4. In this study, living in a low-income ZIP code was not associated with increased severity of illness, longer PICU length of stay (LOS), or readmission.

СOMPLEX APPLICATION OF THE ADAPTED ENHANCE RECOVERY AFTER SURGERY PROGRAMME IN CHILDREN UNDERGOING ORTHOPAEDIC SURGERY

The current concept of Enhance Recovery After Surgery (ERAS) is widely used in adults, but it still remains unexplored in children.Goal of the study. To evaluate the efficacy of the complex application of ERAS programme in children undergoing orthopaedic surgery. Materials and methods. This is a prospective randomized study included 47 patients aged 1-17 years old. The ERAS programme was applied to 22 patients in the study group and it consisted of the following pathways: informing of patients and their parents, avoiding bowel preparation before the surgery, full feeding on the day before surgery and administration of clear carbohydrate drink 2 hours prior induction of anaesthesia, minimization of surgery, regional anaesthesia techniques, postoperative nausea and vomiting (PNV) prophylactics, avoiding opioids perioperatively, euvolemic infusion strategy, normothermia, early postoperative feeding, early postoperative verticalization and mobilization in the 1st postoperative day, no drains and catheters, determining of criteria for safe discharge. Patients in control group (n=25) we did not apply the whole complex of ERAS pathways, but managed them in according to the current recommendations for preoperative fasting, PNV prophylactics, intraoperative fluid therapy, and surgery was also minimized. The primary outcome was the length of stay (LOS) in the hospital up to achieving of discharge criteria. Secondary outcomes were orthostatic tolerance and activity in the 1st postoperative day and patients’ wellbeing (10-point scale) next morning after surgery. Results of the study. LOS was significantly low in the study group (5,6 ± 3,4 vs. 8,9 ± 3,5, р=0,002). All patients (100%) in the study group and 19 patients in the control group successfully took a vertical position on the 1st day after surgery. Patients’ wellbeing in the morning of the next day after surgery was rated as 7,86 ± 1,61 in the study group and 6,52 ± 1,81 in the control group (р=0,01).Conclusions. The results of the study suggests the positive impact of the complex application of ERAS programme on wellbeing and activity of patients and reduced LOS in children in orthopaedic surgery.

Predictors of a Prolonged Length of Stay in Children with Perforated Appendicitis

Predictors of a Prolonged Length of Stay in Children with Perforated Appendicitis

Antibiotic Use and Length of Stay in Children Hospitalized with RSV Lower Respiratory Tract Infection (LRTI)

Antibiotic Use and Length of Stay in Children Hospitalized with RSV Lower Respiratory Tract Infection (LRTI)