AT Pediatric Hospital Medicine 2015

SAN ANTONIO (FRONTLINE MEDICAL NEWS)Pediatric pneumonia patients were found to have a significantly longer length of hospital stay and a higher rate of complications when they also had mood or anxiety disorders, in a study of nearly 35,000 hospitalizations.

Children with chronic complex illnesses have been shown to have longer hospital stays when they also have mood or anxiety disorders; less is known, however, about how these disorders affect children hospitalized for more common conditions, according to Dr. Stephanie Doupnik.

At the Pediatric Hospital Medicine 2015 meeting, Dr. Doupnik of the Children’s Hospital of Philadelphia presented research aimed at understanding the effect of mood and anxiety disorders on complications and length of stay in pediatric pneumonia patients.

Dr. Doupnik and her colleagues used the 2012 Kids’ Inpatient Database to identify 34,795 hospitalizations nationwide for pneumonia among children and adolescents aged 5-20. Of those 13 and older (28% of the cohort), a mood or anxiety diagnosis was recorded at discharge for 9.3%, and in school-age children, for 1.1%. Those diagnoses included major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. (Some studies have looked at attention-deficit/hyperactivity disorder and those outcomes, but children with ADHD were not part of the current study.)

Pneumonia complications such as respiratory failure, sepsis, and suppuration were seen in 10.7% of the younger children, and 18.7% of those 13 and older.

The researchers found that the odds of experiencing any complication were significantly higher in children with mood and anxiety disorders, regardless of age. The older children saw an odds ratio of 1.8 (95% confidence interval, 1.3-2.0) and the younger children, 1.6 (95% CI, 13-2.0) (P less than 0.001 for both). Length of stay also was prolonged among the patients with mood and anxiety disorders by 11% in the younger children and by 13% in the adolescents and young adults.

Dr. Doupnik and her colleagues suspected that an increased rate of complications might explain the differences in length of stay. But they found, in analyzing records for adolescents without complications, that length of stay was still longer (6.8 vs. 5.4 days) for those with mood disorders. Among adolescents with complications, length of stay was still slightly higher in the mood disorder group (4.4 vs. 3.7 days). These differences were statistically significant.

No statistically significant interaction was seen between complications and a mood or anxiety disorder diagnosis at discharge. “If complications were accounting for that prolonged length of stay, we would have expected differences between those groups,” Dr. Doupnik said at the meeting, sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, the AAP Section on Hospital Medicine, and the Academic Pediatric Association.

“It appears that complications do not account for the increase in length of stay among patients with mood and anxiety disorders,” she said.

Dr. Doupnik noted as a limitation of her study a lack of granularity in the data “that would allow us to identify other factors that might be contributing to this association.”

Dr. Doupnik said in an interview that she came to the study having noted that many patients with mental health disorders had more trouble during their hospitalizations. Although this phenomenon has been studied among children with chronic complex illnesses, such as sickle cell disease, diabetes, and cystic fibrosis, “there was a gap in the literature around general pediatric conditions” such as pneumonia, she said.

One potential reason for the association between mental health disorders and length of stay might be delays in presentation to the hospital, Dr. Doupnik said. Also, “there’s the possibility that patients interact differently with staff and providers in the hospital. If they can’t cope as well with the things that need to happen during a hospitalization, that could prolong their length of stay or increase risk of complications.”

Because absolute length of stay differences seen in the study were not very great, it was unlikely that the mood and anxiety disorders developed in the hospital, she noted, adding that the discharge diagnoses likely reflected preexisting diagnoses.

Dr. Doupnik is now planning a prospective cohort study among children admitted to her institution for pneumonia, hoping to help clarify some of the lingering questions surrounding the associations seen in this study.

She disclosed no outside funding or conflicts of interest.