19 - Epidemiology of resource use and outcomes in pediatric acute respiratory failure

Poster Number: 19
Publication Number: 19.201

Folafoluwa O. Odetola, University of Michigan Medical School, Ann Arbor, MI, United States; Achamyeleh Gebremariam, University of Michigan Medical School, Ypsilanti, MI, United States

Background: Acute respiratory failure is a common cause of child hospitalization. Children with respiratory failure recalcitrant to conventional ventilator modes and adjunctive therapies often require specialized organ-supportive technology to enhance the likelihood of salutary outcomes. Given hospital variation in availability of these specialized technologies, efforts to improve outcomes might be enhanced by identification of not only patient-level characteristics but also hospital characteristics that might be associated with patient outcomes and resource use.

Objective: Among children with acute respiratory failure, to test the hypothesis that in-hospital mortality, duration of hospitalization, and hospital charges are associated with factors other than illness severity.

Design/Methods: Retrospective study of children 0-20 years old hospitalized for acute respiratory failure, using the 2019 Kids' Inpatient Database. After descriptive and bivariate analyses, multivariate regression methods identified patient and hospital factors independently associated with in-hospital mortality, duration of hospitalization, and hospital charges.

Results: Of an estimated 76,071 hospitalizations for pediatric acute respiratory failure nationally in 2019, most (97%) were to urban teaching hospitals, 57% were of children < 6 years, and 58% were male. Comorbidities were present in 62% of children, 13% had multiple organ dysfunction, and 54% had extreme illness severity. In-hospital mortality was 7%, average length of stay was 15 days, and average hospital charge was $281,969. Higher mortality was independently associated with transfer, higher illness severity, cumulative organ dysfunction, more comorbidities, and receipt of cardiopulmonary resuscitation. Lower mortality was associated with extracorporeal membrane oxygenation and tracheostomy. Longer hospitalization was associated with transfer, infancy, more comorbidities, higher severity of illness, cumulative organ dysfunction, and urban hospitals. Higher hospital charges were associated with non-infancy, cumulative organ dysfunction, private insurance, and urban teaching hospitals.Conclusion(s): In-hospital mortality and resource use are substantial in pediatric acute respiratory failure. Efforts to reduce mortality should be age-specific and focused on improved understanding of interhospital transfer and access to organ-supportive technology. Further research is needed to enhance understanding of the drivers of the observed longer hospitalization and accrued higher charges predominantly at urban hospitals.