Readmission After Pneumonia Common for Children

Laurie Barclay, MD

June 24, 2014

Readmissions are common after hospitalization for pneumonia and result in considerable costs, according to a retrospective cohort study published online June 23 in Pediatrics. Readmissions are particularly common among young children and those with chronic comorbidities.

"Pneumonia is a leading cause of hospitalization and readmission in children," write Mark I. Neuman, MD, MPH, from the Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, and colleagues. "Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs."

The investigators aimed to determine readmission rates among children previously hospitalized with pneumonia, as well as to identify characteristics and costs linked to readmission.

The retrospective cohort for this study consisted of 82,566 children hospitalized with pneumonia at the 43 hospitals included in the Pediatric Health Information System between January 1, 2008, and December 31, 2011. Median age was 3 years (interquartile range, 1 - 7 years).

All-cause readmission within 30 days after hospital discharge was the main study endpoint, and pneumonia-specific readmission was the secondary endpoint. The researchers used multivariable regression models to determine the patient-related and hospital-related factors and costs associated with readmission.

Within 30 days of discharge, 7.7% of children were readmitted for any cause, and 3.1% were readmitted for pneumonia. Factors associated with higher readmission rates were age younger than 1 year, previous hospitalizations, longer index hospitalizations, care in hospitals with lower volumes of admissions for pneumonia, complicated pneumonia, and chronic medical conditions.

Compared with children without chronic medical conditions, those with such comorbidities were 3 times more likely to be readmitted for any cause (odds ratio [OR], 3.0; 95% confidence interval [CI], 2.8 - 3.2) and nearly twice as likely to be readmitted for pneumonia (OR, 1.8; 95% CI, 1.7 - 2.0).

Readmissions usually occurred shortly after hospital discharge, and more than one third occurred within 1 week, highlighting the importance of follow-up within a few days of discharge and of improving coordination of care with outpatient providers.

High Costs of Readmissions

The median cost of a readmission ($11,344) was more than twice as high as that of an index admission ($4495; P = .01). Although 8% of pneumonia hospitalizations resulted in readmissions, these accounted for 16.3% of total costs for all pneumonia hospitalizations.

"Readmissions are common after hospitalization for pneumonia, especially among young children and those with chronic medical conditions, and are associated with substantial costs," the authors write.

Limitations of this study include reliance on available clinical and administrative data to evaluate and control for differences in illness severity, creating the potential for residual confounding. In addition, the findings may not be generalizable to nonchildren's hospitals, and the investigators were unable to estimate the baseline rate of pneumonia hospitalization.

"Approximately 8% of children experience a readmission within 30 days of pneumonia hospitalization, and children <1 year of age and those with chronic medical conditions are at higher risk of readmission," the study authors conclude. "Our findings may help to target interventions and provide anticipatory guidance for clinicians and for patients at greatest risk of hospital readmission."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 23, 2014. Abstract

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