Readmission after Gastrointestinal Bleeding in Children: A Retrospective Cohort Study

J Pediatr. 2017 May;184:106-113.e4. doi: 10.1016/j.jpeds.2017.01.044. Epub 2017 Feb 23.

Abstract

Introduction: To compare the demographic, clinical, and therapeutic characteristics in a cohort of patients discharged following acute gastrointestinal bleeding, representing to the emergency department (ED) and readmitted within 30 days of discharge with the characteristics of non-readmitted patients.

Study design: Hospitalization data was obtained from the Pediatric Hospital Information System including 49 tertiary children's hospitals in the US. Children 1-21 years of age diagnosed with acute gastrointestinal bleeding, admitted between January 2007 and September 2015 were included. The primary outcomes in this study were 30-day inpatient readmission through the ED and 30-day return to the ED only. Unadjusted, univariate followed by multivariable analysis of the associations between patient characteristics and treatment course at the index encounter using the R statistical package, v. 3.2.3.

Results: During the study period, 9902 patients were admitted with acute gastrointestinal bleeding; in the following month, 1460 (16.1%) represented to the ED and 932 (9%) were readmitted; 68.7% within 14 days from discharge. Readmission was most frequently associated with portal hypertension or esophageal variceal hemorrhage. There was a decreased likelihood of readmission with endoscopy (OR 0.77, 95% CI, 0.661, 0.906) and with Meckel scan (OR 0.513, 95% CI 0.362, 0.727) during the initial admission. Multiple comorbidities, longer initial stay and the early proton pump inhibitor therapy were associated with higher likelihood of readmission.

Discussion: Readmission following acute gastrointestinal bleeding is common and is more likely following variceal hemorrhage, long initial admission, and chronic comorbidities.

Keywords: complications; endoscopy; gastroenterology; hemorrhage; outcomes; pediatric; readmission.

MeSH terms

  • Acute Disease
  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Infant
  • Male
  • Multivariate Analysis
  • Patient Readmission / statistics & numerical data*
  • Recurrence
  • Retrospective Studies
  • Young Adult