National Trends of Aspiration Pneumonia Admissions in the Pediatric Patient Population from 2006 – 2016 and the Association of Aerodigestive Programs on those Admission rates in the United States Open Access

Shah, Rhea (Spring 2020)

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Background: Aspiration pneumonia occurs when someone aspirates a large amount of food and particles, leading to harmful bacteria being deposited into their lungs causing a pulmonary infection. It is a cause of serious mortality and morbidity among people of all ages but there is a lack of data on patient characteristics for hospitalizations in the pediatric patient population. This study aims to look at patient characteristics of children hospitalized with a diagnosis of aspiration pneumonia and explore the association between the prevalence of aerodigestive programs, which function as a multidisciplinary center to manage care for patients with aerodigestive disorders and its impact on hospitalizations of children with ASP in hospitals from 2006-2016 within the United States. 

Methods and Findings: A secondary data analysis was conducted in SAS utilizing data from the Kids’ Inpatient Database. ICD-9 and ICD-10 diagnoses codes for principal diagnosis of aspiration pneumonia were used to identify the study population. There were a total of 25,267 hospitalizations in the United States for aspiration pneumonia during the study period but there was a lower number of admissions in 2016 than 2006. Exploratory analysis and descriptive statistics were used to explore patient and hospital characteristics and associations of categorical variables were tested with Chi square or Fisher’s exact tests, as applicable, and continuous variables were compared using the Wilcoxon rank-sum test. Children that were white, male or used public insurance were more likely to be diagnosed ASP (p-value <.0001). Pediatric patients were more likely to be admitted into urban, teaching hospitals and hospitals with larger bed size (p<.0001). Compared to people whose principal diagnoses was not aspiration pneumonia, patients with aspiration pneumonia had a greater number of chronic conditions, a higher length of stay in the hospital as well as higher hospital costs (p<.0001). The number of aerodigestive programs and hospitalizations from aspiration pneumonia within the United States data were also compared in order to assess for an association. We found that aerodigestive programs are thriving, especially since the last 5 years and have proliferated in academic centers, especially in the South and West region of the United States. When we looked at regional distribution of hospital admissions for those admitted at the academic centers only, we found that the number of admissions were lower in the South and West region of the United States in 2016, compared to 2006. 


Conclusion: This study showed that the overall rate of hospital admissions for the pediatric patient population in the United States was lower in 2016  than  2006. However, the association  between the  lower number could be due to due to readmissions because patients were subsequently treated at an aerodigestive program, thereby addressing underlying causes for ASP and preventing further illness, or if a patient was identified prior to developing ASP and referred to an aerodigestive program, thereby never needing admission. However, more research is needed on where these programs operate, utilization of these programs by the pediatric patient population, as well as the integration of all that data in order to be able to evaluate health outcomes for patients diagnosed with aspiration pneumonia.

Table of Contents

CHAPTER 1: INTRODUCTION                                                                                             1

Introduction and Rationale                                                                                                           1

Problem Statement                                                                                                                       3

Purpose Statement                                                                                                                        4

Research Question/Objectives/Hypothesis                                                                                  4

Significance Statement                                                                                                                 4

Definition of Terms                                                                                                                      5

CHAPTER 2: LITERATURE REVIEW                                                                                 6

Distribution of Aspiration Pneumonia                                                                                     6

Patient Demographics of Adults                                                                                               7

Hospitalizations, Readmissions and Health Outcomes                                                                8

Patient Demographics of Children                                                                               9

Aspiration pneumonia and Complex Chronic Conditions                                                          9

Readmissions, Health Outcomes and Hospital Charges                                                            10

Hospital Characteristics                                                                                                           11

Treatment and Prevention                                                                                           12

Coordinated Care                                                                                                                        12

Aerodigestive Programs                                                                                                           13

Contradicting Studies on overall reduction in charges                                                  15

Conclusion                                                                                                                                 16


CHAPTER 3: METHODS                                                                                                       17


Introduction                                                                                                                              17

Population and sample                                                                                                             17

Instruments                                                                                                                         17

Procedures                                                                                                                           18

Ethical considerations                                                                                                        20

Limitations and delimitations                                                                                                 20


CHAPTER 4: RESULTS                                                                                                         21

Table 1: National and regional estimates of patients diagnosed with aspiration pneumonia from 2006-2016                                                                                                                                     21

Figure 1: National estimates of hospital admissions of patients diagnosed with aspiration

pneumonia (ASP) from 2006-2016                                                                                             21

Figure 2: Regional estimates of hospital admissions of patients diagnosed with aspiration pneumonia (ASP) from 2006-2016.                                                                                           22

Table 2: Demographic data of patients diagnosed with aspiration pneumonia between 2006-2016                                                                                                                                                                 22

Table 3: Hospital demographics for patients diagnosed with aspiration pneumonia between 2006-

2016 stratified by years                                                                                                              24

Table 4: Comparison of hospital data for patients diagnosed with aspiration pneumonia to patients

without aspiration pneumonia                                                                                                    25 

Table 5: Information on aerodigestive programs in the United States stratified by region       26

Table 6: Information on aerodigestive programs in the United States stratified by year, region 

and program type                                                                                                                    26

National and regional estimates                                                                                              27

Patient demographics                                                                                                               27

Hospital demographics                                                                                                            28

Length of Stay and Total Cost of Hospitalization                                                                      28

Number of chronic conditions                                                                                                     29

Hospital Control/ Ownership                                                                                           29

Aerodigestive Programs                                                                                                              30

CHAPTER 5: DISCUSSION AND RECOMMENDATIONS                                              31

Discussion                                                                                                                                  31

Recommendations                                                                                                                    35

Strengths and Limitations                                                                                                       36

Conclusion                                                                                                                                 37


REFERENCES                                                                                                                   38

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