PGY-3 Northwell Health Cohen Children's Medical Center Oakland Gardens, New York, United States
Background: Acute Chest Syndrome (ACS), asthma, and pneumonia collectively account for a significant number of hospitalizations among patients with Sickle Cell Disease (SCD) and contribute significantly to disease burden and mortality. The primary goal of this study was to determine the factors and comorbidities that affect length of stay (LOS) in sickle cell patients admitted with respiratory complications. The secondary goal was to compare LOS for sickle cell patients with respiratory complications compared to patients admitted for pain crises.
Design/Methods: We conducted a retrospective chart review of 95 pediatric admissions (aged 2-21 years) with a history of SCD and admission diagnosis of ACS, asthma, or pneumonia and 205 patients admitted for pain crises at Cohen Children’s Medical Center from 2017-18. We conducted univariate and multivariate Poisson regression analyses to determine associations between patient demographics, baseline hemoglobin, temperature, oxygen saturation, co-diagnoses, treatment and LOS. A multivariate analysis compared LOS between patients admitted for respiratory complications and those admitted with pain crises.
Results: Univariate analysis showed type of SCD, fever at baseline, adolescent age, season of admittance, age as continuous factor, baseline temperature, IV pain medication administration and highest temp on hospital on Day 1 had significant effects on LOS. Multivariate analysis revealed an increase in the number of days to discharge as the subject's highest temperature on Day 1 increased, after adjusting for patient’s age (p<0.0001). Also, as age increased, LOS increased after adjusting for the subject’s temperature (p<0.0001). There was no significant difference in LOS between respiratory admissions and pain crisis admissions (p=0.61). Conclusion(s): This single center retrospective study demonstrates that increasing age, height of fever, SS subtype and winter admissions were associated with longer LOS in children with SCD admitted for respiratory complications. These factors can be used to risk-stratify patients who are being admitted for acute chest syndrome, asthma, or pneumonia. Patients in these high-risk groups may require additional monitoring and could be the focus for inpatient guidelines or clinical scoring systems aimed at improving clinical outcomes and rapidly assessing clinical deterioration. Further research is necessary to investigate the correlation between increased LOS and long-term clinical outcomes.
Authors/Institutions: Sanjiv Godse, Cohen Children's Medical Center, Queens, New York, United States; Joanna Fishbein, Cohen Children's Medical Center, Queens, New York, United States; Shivali Vashisht, Northwell Health, Oakland Gardens, New York, United States; Danielle Madera, Northwell Health, Oakland Gardens, New York, United States; Abena O. Appiah-Kubi, Cohen Children's Medical Center, Queens, New York, United States; Banu Aygun, Cohen Children's Medical Center, Queens, New York, United States; Maria T. Santiago, Cohen Children's Medical Center, Queens, New York, United States