Andrea M Knight1, Pamela F Weiss, Knashawn H Morales, Ron Keren. 1. From the Division of Rheumatology, the Division of General Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: In the setting of recent healthcare advances and emphasis on reduced spending, we aimed to characterize US trends in inpatient healthcare use and mortality for pediatric systemic lupus erythematosus (SLE). METHODS: We performed a retrospective, serial, cross-sectional analysis of the national Kids' Inpatient Database (for 2000, 2003, 2006, and 2009). We identified patients with SLE aged 2 to 21 years using an International Classification of Diseases, 9th revision (ICD-9) code of 710.0 listed as a discharge diagnosis. Using sampling weights, we estimated trends in hospitalization, inpatient mortality, procedure rates, and length of stay (LOS). We analyzed patient and hospital-specific risk factors for mortality and LOS, and compared those outcomes to those without SLE. RESULTS: We identified 26,903 estimated pediatric SLE hospitalizations. The hospitalization rate of 8.6 (95% CI 7.6-9.6) per 100,000 population and mean LOS of 5.9 days (95% CI 5.6-6.2) were stable over time. We found a significant downward trend in mortality, decreasing from 1% to 0.6% (p = 0.04), which paralleled a less pronounced trend for those without SLE. The rate of dialysis, blood transfusions, and vascular catheterization procedures increased. Patients with SLE nephritis and non-white race were at risk for increased healthcare use and death. CONCLUSION: Pediatric SLE hospitalization rate and LOS remained stable, but inpatient mortality decreased as the rate of common therapeutic procedures increased. More research is needed to understand the drivers of these relationships.
OBJECTIVE: In the setting of recent healthcare advances and emphasis on reduced spending, we aimed to characterize US trends in inpatient healthcare use and mortality for pediatric systemic lupus erythematosus (SLE). METHODS: We performed a retrospective, serial, cross-sectional analysis of the national Kids' Inpatient Database (for 2000, 2003, 2006, and 2009). We identified patients with SLE aged 2 to 21 years using an International Classification of Diseases, 9th revision (ICD-9) code of 710.0 listed as a discharge diagnosis. Using sampling weights, we estimated trends in hospitalization, inpatient mortality, procedure rates, and length of stay (LOS). We analyzed patient and hospital-specific risk factors for mortality and LOS, and compared those outcomes to those without SLE. RESULTS: We identified 26,903 estimated pediatric SLE hospitalizations. The hospitalization rate of 8.6 (95% CI 7.6-9.6) per 100,000 population and mean LOS of 5.9 days (95% CI 5.6-6.2) were stable over time. We found a significant downward trend in mortality, decreasing from 1% to 0.6% (p = 0.04), which paralleled a less pronounced trend for those without SLE. The rate of dialysis, blood transfusions, and vascular catheterization procedures increased. Patients with SLE nephritis and non-white race were at risk for increased healthcare use and death. CONCLUSION: Pediatric SLE hospitalization rate and LOS remained stable, but inpatient mortality decreased as the rate of common therapeutic procedures increased. More research is needed to understand the drivers of these relationships.
Entities:
Keywords:
HOSPITALIZATION; LENGTH OF STAY; MORTALITY; PEDIATRIC; SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Ellen M Ginzler; Mary Anne Dooley; Cynthia Aranow; Mimi Y Kim; Jill Buyon; Joan T Merrill; Michelle Petri; Gary S Gilkeson; Daniel J Wallace; Michael H Weisman; Gerald B Appel Journal: N Engl J Med Date: 2005-11-24 Impact factor: 91.245
Authors: C Grootscholten; G Ligtenberg; E C Hagen; A W L van den Wall Bake; J W de Glas-Vos; M Bijl; K J Assmann; J A Bruijn; J J Weening; H C van Houwelingen; R H W M Derksen; J H M Berden Journal: Kidney Int Date: 2006-07-05 Impact factor: 10.612
Authors: Frédéric A Houssiau; Carlos Vasconcelos; David D'Cruz; Gian Domenico Sebastiani; Enrique de Ramon Garrido Ed; Maria Giovanna Danieli; Daniel Abramovicz; Daniel Blockmans; Alessandro Mathieu; Haner Direskeneli; Mauro Galeazzi; Ahmet Gül; Yair Levy; Peter Petera; Rajko Popovic; Radmila Petrovic; Renato Alberto Sinico; Roberto Cattaneo; Josep Font; Geneviève Depresseux; Jean-Pierre Cosyns; Ricard Cervera Journal: Arthritis Rheum Date: 2002-08
Authors: Ginger Carls; Tracy Li; Pantelis Panopalis; Shaohung Wang; Amy G Mell; Teresa B Gibson; Ron Z Goetzel Journal: J Occup Environ Med Date: 2009-01 Impact factor: 2.162
Authors: Gerald B Appel; Gabriel Contreras; Mary Anne Dooley; Ellen M Ginzler; David Isenberg; David Jayne; Lei-Shi Li; Eduardo Mysler; Jorge Sánchez-Guerrero; Neil Solomons; David Wofsy Journal: J Am Soc Nephrol Date: 2009-04-15 Impact factor: 10.121
Authors: Linda T Hiraki; Candace H Feldman; Francisco M Marty; Wolfgang C Winkelmayer; Hongshu Guan; Karen H Costenbader Journal: Arthritis Care Res (Hoboken) Date: 2017-09-21 Impact factor: 4.794
Authors: Bin Liu; ShangAn Shu; Thomas P Kenny; Christopher Chang; Patrick S C Leung Journal: Clin Rev Allergy Immunol Date: 2014-10 Impact factor: 8.667
Authors: Gregory Katz; Nathaniel R Smilowitz; Ashira Blazer; Robert Clancy; Jill P Buyon; Jeffrey S Berger Journal: Mayo Clin Proc Date: 2019-07-11 Impact factor: 7.616