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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Association of hospital and provider types on sickle cell disease outcomes
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Association of hospital and provider types on sickle cell disease outcomes

机译：医院和提供者类型对镰状细胞疾病结果的类型

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OBJECTIVES: Adolescents and young adults (A/YA) with sickle cell disease (SCD) are hospitalized in both children's and general hospitals. We determined the effect of hospital type and provider specialty on outcomes of hospitalized A/YA with SCD and acute chest syndrome (ACS). METHODS: This retrospective cohort study used the 2007-2009 Premier Database, a large multi-institutional database, to identify 1476 patients ages 16 to 25 years with 2299 admissions with SCD and ACS discharged from 256 US hospitals from 2007 to 2009. Multilevel logistic regression and zero-truncated negative binomial regression were performed after adjustment for patient demographic, clinical, and hospital characteristics to test the association of hospital type and provider specialty on death, endotracheal intubation, simple or exchange transfusion, length of stay (LOS), and 30-day readmission. RESULTS: Of all admissions, 14 died and 45% were intubated. General hospitals had 13 deaths and were associated with higher intubation rates (predicted probability [PP], 48% [95% confidence interval (CI), 43%-52%]) and longer LOS (predicted mean LOS, 7.6 days [95% CI, 7.2-7.9]) compared with children's hospitals (PP of intubation, 24% [95% CI, 5%-42%]; and predicted mean LOS, 6.8 days [95% CI, 5.6- 5.8]). There was no difference by hospital type or provider specialty in PP of simple or exchange transfusion, or 30-day readmission. CONCLUSIONS: General hospitals carry higher intubation risks for A/YA with SCD and ACS compared with children's hospitals. We need to better understand the drivers of these differences, including the role of staff expertise, hospital volume, and quality of ongoing SCD care. Pediatrics 2013;132:854-861.
机译：目的：青少年和患有镰状细胞疾病（SCD）的青少年（A / YA）在儿童和综合医院住院。我们确定了医院类型和提供者专业对SCD和急性胸部综合征（ACS）的住院A / YA成果的影响。方法：该回顾性队列研究采用2007-2009普瑞米尔数据库，一个大型多机构数据库，鉴定1676岁至25岁的患者，SCD和ACS从2007年至2009年的256名美国医院签订了2299岁。多级物流回归在调整患者人口统计，临床和医院特征后进行零截断的负二进制回归，以测试医院类型和提供者专业对死亡，气管插管，简单或交换输血，逗留时间（LOS）和30个 - 日入院。结果：所有入院，14人死亡，45％被提交。综合医院有13例死亡，与更高的插管率相关（预测概率[PP]，48％[95％置信区间（CI），43％-52％]）和更长的洛杉矶（预测的平均值，7.6天[95％] CI，7.2-7.9]）与儿童医院（插管PP，24％[95％CI，5％-42％];预测的平均值LOS，6.8天[95％CI，5.6-5.8]）。在简单或交换输血的PP中，医院类型或提供者专业没有差异，或30天的阅览。结论：与儿童医院相比，综合医院对SCD和AC的A / YA提供更高的插管风险。我们需要更好地了解这些差异的驱动因素，包括员工专业知识，医院容量和持续的SCD护理质量的作用。 2013年儿科; 132：854-861。

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