Factors Associated With Discharge on Baseline Respiratory Support for Children With Tracheostomy Hospitalized With Bacterial Tracheostomy-Associated Infections: A Multicenter Observational Cohort Study

Résumé fourni par la source

Abstract Rationale: Bacterial tracheostomy-associated infections (bTRAINs) are a leading cause of hospitalization among children who are tracheostomy dependent, and patients are sometimes discharged on higher respiratory support. Our objective is to determine how different factors affect discharge respiratory settings. We hypothesized that home health nursing (HHN) is associated with increased odds of discharge with higher respiratory settings compared to those without HHN. Methods: We conducted a multi-center, prospective cohort study that included children ≤21 years old with tracheostomy hospitalized for a bTRAIN from one of six freestanding children's hospitals between 2020-2022. We excluded children who received pre-hospitalization antibiotic treatment or who died during the hospitalization. Our primary outcome was a binary outcome defined as higher respiratory settings at discharge (higher oxygen or ventilator needs). Demographic and clinical factors were summarized by higher respiratory support at discharge groups (median (IQR) for continuous variables; count (%) for categorical variables). Bivariate associations of each factor with the outcome variable were analyzed using logistic regression with generalized estimating equations (GEE) to account for correlated patient visits. Multivariable logistic regression with GEE was used to look at associations between factors that were significantly associated in bivariate models or confounders. Results: We included 378 children representing 560 hospitalizations. The median age at admission was 5 years (IQR 2-12 years) and 71.3% had public insurance only. Most (59.1%) lived at home with HHN. The median length of stay (LOS) for the entire group was 8 days (IQR 5-14 days). For our primary outcome, 21.7% (n=122) were discharged on higher respiratory settings than their baseline. In our multivariable model (Table), there was no association between pre-admission HHN and higher respiratory support at discharge. Higher oxygen requirements (p=0.02), acute ventilatory support (p=0.007), and acute on chronic ventilatory support (p=0.001) during hospitalization were associated with higher odds of discharge on higher support when compared to those on their chronic (baseline) support. The 30-day bTRAIN readmission rates were 3.2% (n=18) in the total sample; 4.9% (n=6) of those discharged on higher respiratory settings readmitted compared to 2.7% (n=12) discharged on baseline settings (p=0.34). Conclusions: Children admitted for bTRAINs who required higher oxygen or ventilator support during hospitalization were more likely to be discharged on higher respiratory settings. Readmission rates were rare whether discharged on baseline or higher respiratory settings, though we may have been underpowered to detect statistically significant differences.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.