Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children

Author:

Spear Matthew B.1,Miller Kristen2,Press Craig3,Ruzas Christopher4,LaVelle Jaime5,Mourani Peter M.6,Bennett Tellen D.47,Maddux Aline B.4ORCID

Affiliation:

1. Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA

2. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

3. Department of Pediatrics, Division of Neurology, University of Pennsylvania School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA

4. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA

5. Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA

6. Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences and Arkansas Children’s, Little Rock, AR, USA

7. Department of Pediatrics, Section of Informatics and Data Science, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

Abstract

Background and Purpose Long-term outcomes after pediatric neurocritical illness are poorly characterized. This study aims to characterize the frequency and risk factors for post-discharge unplanned health resource use in a pediatric neurocritical care population using insurance claims data. Methods Retrospective cohort study evaluating children who survived a hospitalization for an acute neurologic illness or injury requiring mechanical ventilation for >72 hours and had insurance eligibility in Colorado’s All Payers Claims database. Insurance claims identified unplanned readmissions and emergency department [ED] visits during the post-discharge year. For patients without pre-existing epilepsy/seizures, we evaluated for post-ICU epilepsy identified by claim(s) for a maintenance anti-seizure medication during months 6-12 post-discharge. Multivariable logistic regression identified factors associated with each outcome. Results 101 children, median age 3.7 years (interquartile range (IQR) .4-11.9), admitted for trauma (57%), hypoxic-ischemic injury (17%) and seizures (15%). During the post-discharge year, 4 (4%) patients died, 26 (26%) were readmitted, and 48 (48%) had an ED visit. Having a pre-existing complex chronic condition was independently associated with readmission and emergency department visit. Admission for trauma was protective against readmission. Of those without pre-existing seizures (n = 86), 25 (29%) developed post-ICU epilepsy. Acute seizures during admission and prolonged ICU stays were independently associated with post-ICU epilepsy. Conclusions Survivors of pediatric neurocritical illness are at risk of unplanned healthcare use and post-ICU epilepsy. Critical illness risk factors including prolonged ICU stay and acute seizures may identify cohorts for targeted follow up or interventions to prevent unplanned healthcare use and post-ICU epilepsy.

Funder

Francis Family Foundation

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Publisher

SAGE Publications

Subject

Neurology (clinical)

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