Hospital Readmissions Among Children With H1N1 Influenza Infection

Thomas V Brogan; Matthew Hall; Marion R Sills; Evan S Fieldston; Harold K Simon; Michael B Mundorff; Daniel B Fagbuyi; Samir S Shah

doi:10.1542/hpeds.2014-0045

Hospital Readmissions Among Children With H1N1 Influenza Infection

Hosp Pediatr. 2014 Nov;4(6):348-58. doi: 10.1542/hpeds.2014-0045.

Authors

Thomas V Brogan¹, Matthew Hall², Marion R Sills³, Evan S Fieldston⁴, Harold K Simon⁵, Michael B Mundorff⁶, Daniel B Fagbuyi⁷, Samir S Shah⁸

Affiliations

¹ Seattle Children's Hospital, and Department of Pediatrics, Division of Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington botcho@u.washington.edu.
² Children's Hospital Association, Overland Park, Kansas.
³ University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
⁴ Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁵ Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
⁶ Department of Systems Improvement, Children's Primary Hospital, Salt Lake City, Utah.
⁷ The George Washington University School of Medicine, and Children's National Medical Center, Washington, District of Columbia.
⁸ Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics and Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.

PMID: 25362076
DOI: 10.1542/hpeds.2014-0045

Abstract

Objectives: To describe readmissions among children hospitalized with H1N1 (influenza subtype, hemagglutinin1, neuraminidase 1) pandemic influenza and secondarily to determine the association of oseltamivir during index hospitalization with readmission.

Methods: We reviewed data from 42 freestanding children's hospitals contributing to the Pediatric Health Information System from May through December 2009 when H1N1 was the predominant influenza strain. Children were divided into 2 groups by whether they experienced complications of influenza during index hospitalization. Primary outcome was readmission at 3, 7, and 30 days among both patient groups. Secondary outcome was the association of oseltamivir treatment with readmission.

Results: The study included 8899 children; 6162 patients had uncomplicated index hospitalization, of whom 3808 (61.8%) received oseltamivir during hospitalization, and 2737 children had complicated influenza, of whom 1055 (38.5%) received oseltamivir. Median 3-, 7-, and 30-day readmission rates were 1.6%, 2.5%, and 4.7% for patients with uncomplicated index hospitalizations and 4.3%, 5.8%, and 10.3% among patients with complicated influenza. The 30-day readmission rates did not differ by treatment group among patients with uncomplicated influenza; however, patients with complicated index hospitalizations who received oseltamivir had lower all-cause 30-day readmissions than untreated patients. The most common causes of readmission were pneumonia and asthma exacerbations.

Conclusions: Oseltamivir use for hospitalized children did not decrease 30-day readmission rates in children after uncomplicated index hospitalization but was associated with a lower 30-day readmission rate among children with complicated infections during the 2009 H1N1 pandemic. Readmission rates for children who had complicated influenza infection during index hospitalizations are high.

Keywords: H1N1 influenza virus; Pediatric Health Information System; antivirals; readmission.

Grants and funding

R03 HS016418/HS/AHRQ HHS/United States