Background

The burden and characteristics of unplanned readmission after epilepsy-related discharge in children in the United States is not known.

Methods

We undertook a retrospective cohort study of children aged one to 17 years discharged after a nonelective hospitalization for epilepsy, sampled from the Healthcare Cost and Utilization Project’s 2013 and 2014 Nationwide Readmissions Database. Descriptive statistics and logistic regression models were used to examine the characteristics of initial hospitalization and risk factors for readmission.

Results

A total of 42,873 admissions for unique patients were identified, with 4470 (10.4%) leading to readmission within 30 days. The most common readmission diagnosis was epilepsy (24.9%). Neurodevelopmental diagnoses including cerebral palsy, intellectual disability, and developmental delay were associated with increased odds of readmission. Longer hospitalization, gastrostomy, and tracheostomy were also associated with readmission, but continuous electroencephalography use was not. Children insured by Medicare had a readmission rate of 34.4%, whereas there were no associations of readmission with other sociodemographic characteristics such as neighborhood, income, and sex.

Conclusions

Seizures are among the most frequent reasons for hospitalization in children. Establishing a benchmark readmission rate for pediatric epilepsy of 10.4% may be useful to health systems designing quality improvement efforts. Clinical factors were more strongly associated with readmission than demographic characteristics. Interventions to reduce pediatric epilepsy readmissions may have the highest yield when targeting children with neurodevelopmental comorbidities.

中文翻译：

---

美国癫痫儿童的计划外再次入院。

背景

在美国，儿童癫痫相关出院后意外入院的负担和特征尚不清楚。

方法

我们进行了一项回顾性队列研究，研究对象是从非选择性住院治疗的癫痫发作后出院的1至17岁儿童，该儿童样本来自医疗保健成本与利用项目的2013年和2014年全国再入院数据库。描述性统计和逻辑回归模型用于检查初始住院的特征和再次入院的危险因素。

结果

总共识别出42873名独特患者入院，其中4470名（10.4％）导致30天内再次入院。最常见的再入院诊断是癫痫（24.9％）。神经发育诊断包括脑瘫，智力障碍和发育迟缓与再入院几率增加相关。较长的住院时间，胃造口术和气管切开术也与再入院有关，但连续脑电图检查却没有。由Medicare保险的孩子的再入院率为34.4％，而再入院与其他社会人口统计学特征（如邻里，收入和性别）没有关联。

结论

癫痫发作是儿童住院最常见的原因之一。将小儿癫痫的基准再入院率确定为10.4％，可能对卫生系统设计质量改善工作很有帮助。临床因素与再入院率比人口统计学特征更紧密相关。以神经发育合并症儿童为对象时，减少小儿癫痫再入院的干预措施可能具有最高的收成。