Mortality During Readmission Among Children in United States Children's Hospitals

Mortality During Readmission Among Children in United States Children's Hospitals

Rees CA; Neuman MI; Monuteaux MC; Michelson KA; Duggan CP

Journal of Pediatrics

2022

children’s hospitals; complex chronic conditions; disparities; mortality; pediatric; readmissions; United States

OBJECTIVE: To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization. STUDY DESIGN: We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010-June 2020. Our primary outcome was death during readmission ≤180 days of an index hospitalization among children aged 0-18 years. 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, 12.6% (n=337,385) were readmitted within 180 days of the index hospitalization and 2,913 (0.8%) died during readmission. 26.2% of deaths among children who were readmitted and died occurred within 10 days after discharge from index hospitalizations. Factors independently associated with mortality during readmission included: multiple complex chronic conditions, index admissions lasting >7 days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission than children of other races. CONCLUSIONS: Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.

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