title: High resource hospitalizations among children with vaso-occlusive crises in sickle cell disease.
abstract: BACKGROUND
  Vaso-occlusive crises (VOCs) contribute to frequent hospitalizations among children with sickle cell disease (SCD). The objective of this study was to identify factors associated with high resource utilization during hospitalizations for VOC.
  
  
  METHODS
  We analyzed pediatric discharges 0-18 years of age with a primary diagnosis of SCD with crisis from the 2006 Kids' Inpatient Database, a nationally representative sample of pediatric hospital discharges. High resource hospitalizations were defined as those in the highest decile for total charges. We conducted sample-weighted regression analyses to determine associations between independent variables (patient demographics, hospital characteristics, illness severity) and high resource use.
  
  
  RESULTS
  There were 9,893 (0.371%) discharges for children with VOCs. Median total hospitalization charges were $10,691. In multivariate analysis, children 15-18 years of age (odds ratio [OR] 3.39, 95% confidence interval [CI] 2.54-4.53), 10-14 years of age (OR 2.72, 95% CI 2.07-3.59), and 5-9 years of age (OR 1.74, 95% CI 1.30-2.34) had higher odds of high resource hospitalizations compared to children 0-4 years of age. Care in a children's hospital had three times the odds of high resource use compared to care in a general hospital. Discharges with secondary diagnoses including pneumonia (OR 2.46, 95% CI 1.96-3.09) and constipation (OR 1.78, 95% CI 1.31-2.40) were also associated with high resource use.
  
  
  CONCLUSIONS
  Older age and secondary diagnoses were associated with high resource use during VOC hospitalizations. These findings suggest the need to improve adherence to comprehensive care among older children to prevent VOCs and standardize protocols to manage VOC complications.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Houston, Texas 77030, USA. raphael@bcm.edu
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.forename: Minghua
authors.initials: M
authors.lastname: Mei
authors.forename: Brigitta U
authors.initials: BU
authors.lastname: Mueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Giordano
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications / Q000191:economics* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006769:Hospitals, General / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012720:Severity of Illness Index; D014652:Vascular Diseases / Q000191:economics* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy