Using data from 19 states from 2006 to 2008 over five million pediatric hospitalizations were examined. Pediatric patients who experienced an adverse event had a 6.15% mortality rate and excess cost of $1.3 billion. This quality indicator (QI) was one of the highest volume events. The trend in this QI worsened over time and was one of the most variable across the hospitals studied.
More recently, data from the Healthcare Cost and Utilization Project from 2000 to 2007 were used to examine trends in pediatric care. Accidental puncture and laceration increased 25.6% from 2000 to 2007, with the largest increase for children between the ages of 5 and 14 years. However, the authors did caution that present on admission data were not used and the sample of hospitals varied over the years.
Pediatric Quality Indicator 1 (PDI 1) functions appropriately in pediatric populations to identify adverse events that are associated with excess length of stay and total charges. Using the Nationwide Inpatient Sample from 1998-2005 and the Kid's Inpatient Database (KID) from 1997, 2000, and 2003, Camp and colleagues identified 6,459 unique records flagged by PDI 1, and matched them with 19,377 control records with the same age, race, gender, and hospital identification code. Multiple regression analyses were performed for inpatient mortality, length of stay and total hospital charges (controlling for procedure category, admission type, and insurance status in the matched case-control data set). Adjusted for procedure category, admission type, and insurance status, patients with PDI 1 were more likely to die (odds ratio [OR]: 1.9., P < 0.001), had a 4.81 day longer length of stay (95% confidence interval [CI]: 4.26-5.36, P < 0.001), and had $36,291 higher total hospital charges (95% CI: $32,583-$40,000, P < 0.001) compared with patients without PDI 1.
In a similar study using nearest-neighbor propensity score matching in the Pediatric Health Information System database from 2006 (an administrative database with data from 38 academic, nonprofit pediatric hospitals affiliated with the Child Health Corporation of America), Kronman and colleagues reported mean excess length of stay of 2.77 days and mean excess total charges of $34,884 for each PDI 1 case, relative to matched controls. The excess charges came from all hospital cost centers, including pharmacy ($7,705), supplies ($1,718), laboratory ($7,622), imaging ($1,956), and other clinical activities ($4,827).