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 Público
Shah, Rhea (Spring 2020)
Published
Abstract
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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