Risk Factor Analysis for 30-Day Readmission Rates of Newly Tracheostomized Children

Objectives: Pediatric patients undergo tracheostomy for a variety of reasons; however, medical complexity is common among these patients. Although tracheostomy may help to facilitate discharge, these patients may be at increased risk for hospital readmission. The purpose of this study was to evaluate our institutional rate of 30-day readmission for patients discharged with new tracheostomies and to identify risk factors associated with readmission. Study Design: A retrospective cohort study was conducted for all pediatric patients ages 0-18 years with new tracheostomies at our institution over a 36-month period. Methods: A chart review was performed for all newly tracheostomizedchildren from 2013 to 2016. We investigated documented readmissions within 30 days of discharge, reasons for readmission, demographic variables including age and ethnicity, initial discharge disposition, co-morbidities, and socioeconomic status estimated by mean household income by parental zip code. Results: 45 patients were discharged during the study time period. A total of 13 (28.9%) required readmission within 30 days of discharge. Among these 13 patients, the majority (61.5%) were readmitted for lower airway concerns, many (30.8%) were admitted for reasons unrelated to tracheostomy or respiratory concerns, and only one patient (7.7%) was readmitted for a reason related to tracheostomy itself (tracheostomalbreakdown). Age, ethnicity, discharge disposition, co-morbidities, and socioeconomic status were not associated with differences in readmission rates. Patients readmitted within 30 days had a higher number of admissions within the first year. Conclusion: Pediatric patients with new tracheostomies are at high risk for readmission after discharge from initial hospitalization. The readmissions are most likely secondary to underlying medical complexity rather than issues related specifically to the tracheostomy procedure.https://jdc.jefferson.edu/patientsafetyposters/1046/thumbnail.jp

Castleman Disease in the Pediatric Neck: Case Report and Literature Review

Objective: To investigate the common features of cervical pediatric Castleman disease (CD). Study Design: Case report and literature review of pediatric patients with cervical CD. Methods: Online medical journal databases were searched for patients aged 18 years or younger. Eighteen published papers were found, comprising 29 cases. One case from our institution was also included for a total of 30 patients. Results: An asymptomatic mass in level V was the most common presentation. No gender differences were noted. Multiple forms of imaging were pursued, and no particular modality showed signs specific for CD. All cases were treated with complete surgical excision and diagnosed as hyaline-vascular type on histology, except for one case, where histologic type was not reported. No reports of multicentric disease, plasma cell, or mixed histology were found. No recurrences were reported. Conclusions: This poster provides the largest known literature review of pediatric patients with cervical CD. In our analysis, there is a higher propensity for level V than previously reported in small studies. While CD is rare, it should be considered on the differential for a pediatric neck mass, particularly when presenting with an asymptomatic posterior neck mass and equivocal work-up. Fortunately, our study suggests that, if diagnosed as CD, the most likely diagnosis is hyaline-vascular type for which the long-term prognosis is good. Surgical excision is both diagnostic and therapeutic

Dual Kidney Allocation Score: A Novel Algorithm Utilizing Expanded Donor Criteria for the Allocation of Dual Kidneys in Adults

Abstract: Objective The recognition of wound-related complications following pediatric tracheotomy is on the rise. These complications can have a significant impact on clinical course as well as on hospital healthcare costs to the tracheotomy dependent child and family Methods A tracheotomy database was created in 2000 and reviewed for incidence of major and minor complications. Setting Tertiary Care Pediatric Referral Center Results We identified a post-tracheotomy complication rate of 19.9%, of which the most common complication was wound breakdown (65% of complications). Conclusion Rate of post-tracheotomy wound-care complications is 12.9%. Wound description is subjective and prone to inter-observer variability. A wound classification scheme is proposed to promote consistent evaluation of these complications.https://jdc.jefferson.edu/otoposters/1001/thumbnail.jp