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Discharge Before Return to Respiratory Baseline and Reutilization in Children with Neurologic Impair

Katherine Melink

University of Cincinnati College of Medicine

Introduction: Children with neurologic impairment (NI), who frequently require respiratory support at baseline, are commonly hospitalized with acute respiratory illness (ARI). These children are often discharged prior to complete return to baseline respiratory status. The objective of this study is to determine if discharge before return to respiratory baseline is associated with hospital reutilization among children with NI hospitalized with ARI. Methods: This single center retrospective cohort study included children with NI age 1-18 years hospitalized with ARI between January 2010 and December 2015. The primary exposure was discharge prior to return to respiratory baseline. The primary outcome was 30-day hospital reutilization, defined as emergency department revisit or all-cause readmission. Respiratory baseline support needs and highest respiratory support required during hospitalization were determined using structured chart review. A generalized estimating equation was used to examine the association between discharge before return to respiratory baseline and hospital reutilization while accounting for within patient clustering and additional patient-level covariates. Results: In the 755 hospitalizations experienced by 443 patients, most (83.7%) children required increased respiratory support and 25.3% were discharged before return to baseline. Compared with those discharged at respiratory baseline, children discharged on increased respiratory support were older, more likely to be privately insured, technology-dependent, and have a respiratory comorbidity. They also had higher baseline respiratory support needs, required greater escalation in support, and had longer hospitalizations (median 6 vs 3 days, p<.001). Hospital reutilization within 30 days occurred in 32.3% of patients, with no difference in reutilization rate between children discharged above and those discharged at respiratory baseline (33.0% vs 32.1%, p=0.82). In adjusted analysis controlling for patient complexity and illness severity, discharge before return to respiratory baseline was not associated with 30-day hospital reutilization (adjusted odds ratio, 0.84 [95% confidence interval, 0.54-1.30]). Conclusions: Among children with NI hospitalized with ARI, discharge before return to respiratory baseline was common, but was not associated with hospital reutilization. Return to respiratory baseline may not be a necessary component of discharge criteria in this population.

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