Study objectives

To determine associations between demographic and clinical characteristics and rate of unplanned returns to system (RTS) in pediatric patients discharged with tracheostomy.

Methods

Medical records were examined for pediatric patients discharged after tracheostomy placement between January 1, 2011 and December 31, 2015. Exclusion criteria included death or decannulation prior to discharge and lack of follow-up through 180 days post-discharge. Readmissions were grouped by time interval after discharge (within 30 days or within 31–180 days). Chi-squared analysis and Fisher's Exact Test were utilized to determine associations between patient characteristics, rate and frequency of RTS, and type of admission (Emergency Department [ED] or inpatient [IP]).

Results

One hundred twenty-one patients were eligible for the study, and 80 (66.1 %) had an unanticipated RTS during the follow-up period. Patients with early RTS had a higher total number of RTS. Patients with two or more RTS were more likely to be younger, while patients with five or more RTS were more likely to have greater organ system involvement and cardiovascular (CV) disease in particular. Patients presenting with GI diagnoses were more likely to be discharged from the ED. The rate of RTS remained constant throughout the time period examined.

Conclusion

Pediatric patients discharged with tracheostomy are medically complex and at high risk of RTS, especially for respiratory and GI problems. This risk does not decrease after the initial post-discharge period and long-term follow-up is warranted. Younger patients and patients with history of early RTS are at highest risk for repeat RTS and should be identified for closer outpatient care.

中文翻译：

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气管切开出院儿童复诊危险因素分析

学习目标

确定人口统计学和临床​​特征与气管切开术出院的儿科患者计划外系统恢复率 (RTS) 之间的关联。

方法

对 2011 年 1 月 1 日至 2015 年 12 月 31 日期间气管切开术后出院的儿科患者的医疗记录进行了检查。排除标准包括出院前死亡或拔管以及出院后 180 天缺乏随访。再入院按出院后的时间间隔（30 天内或 31-180 天内）分组。卡方分析和 Fisher 精确检验用于确定患者特征、RTS 的发生率和频率以及入院类型（急诊科 [ED] 或住院患者 [IP]）之间的关联。

结果

121 名患者符合研究条件，80 名 (66.1 %) 在随访期间出现意外 RTS。早期 RTS 患者的 RTS 总数较高。有两个或更多 RTS 的患者更可能更年轻，而有五个或更多 RTS 的患者更有可能有更多的器官系统受累，尤其是心血管 (CV) 疾病。出现 GI 诊断的患者更有可能从 ED 出院。RTS 的速率在整个检查时间段内保持不变。

结论

通过气管切开术出院的儿科患者在医学上很复杂，并且处于 RTS 的高风险中，尤其是呼吸系统和胃肠道问题。这种风险在最初的出院后期后不会降低，需要长期随访。年轻患者和有早期 RTS 病史的患者重复 RTS 的风险最高，应确定进行更密切的门诊护理。