儿科营养不良院内诊断的时间趋势和医疗资源使用率
儿科营养不良与不良结局、住院时间延长、医疗费用增加直接相关。
为此，美国德克萨斯儿童医院、贝勒医学院开展了一项关于住院儿童营养不良的全国横断面回顾调查，调查对象来自2002～2011年美国儿科住院患者数据库记录的1个月～17岁儿童。
结果发现，大约每年210万住院患儿中，营养不良者超过5.46万例。其中，营养不良患儿与无营养不良住院儿童相比，并发症发生率较高、结局较差、医疗资源使用率较高。营养不良患儿诊断率由2002年1.9%增至2011年3.7%，营养不良诊断率按大约8%的速率逐年递增。此外，农村医院、城市非教学医院、城市教学医院的营养不良患儿诊断率存在显著差异。
JPEN J Parenter Enteral Nutr. 2017;41(2):286-287.
Temporal trends, correlates, and healthcare utilization associated with an inpatient diagnosis of pediatric malnutrition, united states, 2002-2011.
Jennifer Carvalho-Salemi; Jason L. Salemi; Molly R. Vega; Kiara K. Spooner; Stacey S. Beer; Nicki Canada; Marisa D. Juarez.
Texas Children's Hospital, Houston, Texas, USA; Baylor College of Medicine, Houston, Texas, USA.
Purpose: Pediatric malnutrition has been associated with adverse clinical outcomes, longer lengths of stay, and higher healthcare costs. The purpose of this study was to characterize temporal trends in pediatric malnutrition across sociodemographic, clinical, and hospital characteristics over a 10-year study period.
Methods: We conducted a retrospective cross-sectional analysis of pediatric inpatient hospitalizations in the United States between 2002 and 2011 using 2 nationally representative databases: the Nationwide Inpatient Sample (NIS) and the Kid's Inpatient Database (KID). In adopting a recently proposed etiology-related definition of pediatric malnutrition, our study population included children hospitalized between 1 month and 17 years of age. ICD-9-CM diagnosis codes were used to identify malnutrition and malnutrition subtypes. We estimated the national frequency and prevalence of pediatric malnutrition overall and across patient sociodemographic, clinical, and hospital characteristics. We used logistic regression to assess associations between malnutrition and each characteristic. We then assessed specific conditions associated with the highest volume and rates of malnutrition to provide clinically meaningful data on burden and risk. We also compared clinical comorbidities, outcomes, and hospital utilization indices between children with and without a diagnosis of malnutrition. Last, we estimated and described temporal trends in pediatric malnutrition diagnoses using joinpoint regression and assessed changes in the relative annual distribution of malnutrition subtypes.
Results: Of the approximately 2.1 million pediatric hospitalizations annually, over 54,600 were diagnosed with malnutrition, corresponding to a national prevalence of 2.6%. Considerable variation was observed based on primary diagnosis; fluid and electrolyte disorders, pneumonia, and esophageal disorders contributed the most malnutrition cases. Compared with the 2.6% overall prevalence, 6 conditions had malnutrition rates at least 5 times higher (eg, stomach cancer, cystic fibrosis, human immunodeficiency virus, atherosclerosis, congestive heart failure, esophageal disorders, enteritis/ulcerative colitis). Compared with hospitalized children without, those with a diagnosis of malnutrition had higher rates of existing comorbidities, worse clinical outcomes, and increased utilization of inpatient services. The proportion of pediatric hospitalized patients that received a diagnosis of malnutrition increased from 1.9% in 2002 to 3.7% in 2011, corresponding to an 8% increase in the rate annually. Each malnutrition subtype and nearly all patient- and hospital-level subgroups experienced statistically significant increases in the rate of diagnosed malnutrition during the study period. There were marked differences in diagnosed malnutrition among rural, urban nonteaching, and urban teaching hospitals.
Conclusions: To our knowledge, this is the first study to use nationally representative databases to comprehensively characterize temporal trends, correlates, and healthcare utilization of pediatric patients with coded malnutrition. Numerous factors may be responsible for the increase in prevalence of malnutrition over time. Improved technology has led to more severely ill patients at risk for malnutrition. Heightened awareness and multidisciplinary clinical teams likely improved recognition and diagnosis. Finally, a movement toward national standards in assessment and coding practices may have allowed for the capture of previously unascertained cases. Despite improvements, pediatric malnutrition remains underdiagnosed in inpatient settings, which underscores the need for a national benchmarking program if we aim to estimate the true prevalence, clinical significance, and cost of pediatric malnutrition.
DOI: 10.1177/0148607116686023