FROM PEDIATRICS

Between 1997 and 2006, the proportion of hospitalizations in the United States for pediatric pulmonary hypertension doubled, from 1 in 1,000 discharges for the condition in 1997 to 1 in 500 in 2006, a national retrospective cohort study found.

“These results have practice and policy implications at the institutional, state, and national levels, particularly in the face of increasing pressure to restrain costs while caring for a population with increasingly complex medical needs,” researchers led by Dr. Bryan G. Maxwell reported online June 6, 2015 in Pediatrics ( doi/10.1542/peds.2014-3834 ).

Dr. Maxwell of the departments of anesthesiology and critical care medicine at Johns Hopkins University, Baltimore, Md., and his associates examined data on pediatric pulmonary hypertension (PH) hospitalizations between 1997 and 2006 from the Kids’ Inpatient Database, which is part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.

Of the estimated 43 million pediatric discharges that occurred between 1997 and 2006, 0.13% were for PH, and discharges for the condition increased over the study period, from 1 in 500 in 1997 to 1 in 1,000 in 2006 (P less than .0001). During the same time period, inflation-adjusted national hospital charges for PH hospitalizations increased from $926 million to 3.12 billion (P = .0003).

The researchers also found that the increase in PH discharges was most pronounced between 2006 and 2012, and that most PH hospitalizations did not occur in dedicated children’s hospitals. The overall mortality of patients discharged with PH was 5.9%, and steadily improved between 1997 and 2012 (P less than .0001).

Dr. Maxwell and his associates acknowledged certain limitations of the study, including the fact that the Kids’ Inpatient Database does not provide longitudinal data on patients with PH over time or on outpatient care, and that ICD-9-CM codes “do not permit accurate identification of subgroups of patients with PH in a way that is consistent with the most current schemata for categorizing PH.”

Despite such limitations, they concluded that the current study “is useful in demonstrating the burgeoning number and nature of pediatric PH hospitalizations and the implications of these trends for resource utilization and public policy.”

The researchers reported having no relevant financial disclosures.

dbrunk@frontlinemedcom.com

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