Key result
Living within 5 miles of the hospital links to ~43% fewer 30-day pediatric sickle cell readmissions.
Observational (n=373)
No
Odds Ratio: 0.573
p-value: p=0.04
Clinical factors such as pain scores and prior hospitalizations, along with geographic proximity to the hospital, are significant predictors of 30-day readmission in pediatric patients with sickle cell crises.
Proximity to hospital was associated with lower pediatric SCD readmission risk; extends clinical models but leaves open need for prospective validation.
BACKGROUND AND OBJECTIVES: Sickle cell disease (SCD) is a blood disorder affecting many US children that is often associated with hospital readmission. Although previous studies have reported on the clinical factors that influence readmission risk, potential geographic factors have not been fully investigated. The goal of this study was to investigate the importance of geographic risk factors and to confirm previously derived clinical risk factors that influence readmissions for SCD pain crises. METHODS: Retrospective analyses were performed on pediatric inpatients with sickle cell crises at a single center. Readmission rates and risk factors were assessed. Geospatial analysis was conducted on point variables that represented health service access, and multivariable logistic regression models were constructed. RESULTS: The study identified 373 patients experiencing sickle cell crises, with 125 (33.5%) having at least one 30-day readmission. Age (mean difference: 2.2 years; P<0.001), length of stay (median difference: 1 day; P<.001), admission pain score>7 of 10 (odds ratio [OR]: 2.21; P<0.01), discharge pain score>4 of 10 (OR: 2.098; P<.01), living within 5 miles of the center's main hospital (OR: 0.573; P=.04), and >3 hospital utilizations in the previous 12 months (OR: 5.103; P<.001) were identified as potential indicators of 30-day readmission risk. Logistic regression models for 30-day readmissions yielded similar results. CONCLUSIONS: Increased age, high admission and discharge pain scores, decreased length of stay, and increased hospital utilizations were found to be associated with an increased risk of readmission for sickle cell crisis. Patient's residence was also found to be a significant risk indicator, supporting the utility of geospatial analysis in assessing readmission risk.
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McMillan et al. (2015) conducted an observational in Pediatric Sickle Cell Crisis (n=373). Living within 5 miles of the center's main hospital vs. Living >5 miles from the center's main hospital was evaluated on 30-day readmission (OR 0.573, p=0.04). Living within 5 miles of the hospital was associated with a lower risk of 30-day readmission (OR 0.573; P=0.04) among pediatric patients with sickle cell crises.
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