207 - Mortality During Readmission Among Children in United States Children’s Hospitals

Poster Number: 207
Publication Number: 207.320

Chris A. Rees, Emory University School of Medicine, Atlanta, GA, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States; Michael C. Monuteaux, Boston Children's Hospital, Boston, MA, United States; kenneth michelson, Boston Children's Hospital, Boston, MA, United States; Christopher Duggan, Boston Children's Hospital, Boston, MA, United States

Background: The United States (US) has the second highest childhood mortality rate among 20 of the world’s most industrialized countries. An analysis of index hospitalizations in the period prior to death, as well as common factors present during the index hospitalization, may allow for the identification of children at short-term risk of death among children in the US.

Objective: To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization.

Design/Methods: We conducted a retrospective cohort study of 33 US children’s hospitals in the Pediatric Health Information System from January 2010-June 2020. Our primary outcome was death during a readmission within 180 days of an index hospitalization. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group categorized illness severity (i.e., minor, moderate, and major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission.

Results: Among 2,677,111 children discharged from hospitalization, 12.6% (n=337,385) were readmitted within 180 days of the index hospitalization and 2,913 (0.8%) died during a readmission. 26.2% of deaths among children who died during readmission occurred within 10 days after discharge from the index hospitalization (Figure). Factors independently associated with death during readmission included: multiple complex chronic conditions, Black race, public insurance, moderate or severe/extreme illness during the index hospitalization, and index admission lasting >7 days (Table).Conclusion(s): Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with death during a readmission. Interventions to reduce mortality in the period after initial hospital admission may target high-risk populations, including children with complex chronic conditions, children whose race is Black, and children with public insurance.
Figure. Timing of readmission with death < 180 days after index hospitalization among children admitted to a US children’s hospital.
Table. Multivariable logistic regression models of factors present during index hospitalization associated with mortality during readmission within 180 days.1Mean number of index cases per hospital per year