title: Clinical and Geographic Characterization of 30-Day Readmissions in Pediatric Sickle Cell Crisis Patients.
abstract: OBJECTIVE
  Sickle cell disease (SCD) is a blood disorder affecting many US children that is often associated with hospital readmission. Although previous studies have reported on the clinical factors that influence readmission risk, potential geographic factors have not been fully investigated. The goal of this study was to investigate the importance of geographic risk factors and to confirm previously derived clinical risk factors that influence readmissions for SCD pain crises.
  
  
  METHODS
  Retrospective analyses were performed on pediatric inpatients with sickle cell crises at a single center. Readmission rates and risk factors were assessed. Geospatial analysis was conducted on point variables that represented health service access, and multivariable logistic regression models were constructed.
  
  
  RESULTS
  The study identified 373 patients experiencing sickle cell crises, with 125 (33.5%) having at least one 30-day readmission. Age (mean difference: 2.2 years; P<0.001), length of stay (median difference: 1 day; P<.001), admission pain score>7 of 10 (odds ratio [OR]: 2.21; P<0.01), discharge pain score>4 of 10 (OR: 2.098; P<.01), living within 5 miles of the center's main hospital (OR: 0.573; P=.04), and >3 hospital utilizations in the previous 12 months (OR: 5.103; P<.001) were identified as potential indicators of 30-day readmission risk. Logistic regression models for 30-day readmissions yielded similar results.
  
  
  CONCLUSIONS
  Increased age, high admission and discharge pain scores, decreased length of stay, and increased hospital utilizations were found to be associated with an increased risk of readmission for sickle cell crisis. Patient's residence was also found to be a significant risk indicator, supporting the utility of geospatial analysis in assessing readmission risk.
authors.affiliation: Center for Pediatric Informatics, jmcmilla@childrensnational.org.
authors.forename: Jefferson E
authors.initials: JE
authors.lastname: McMillan
authors.affiliation: Center for Cancer and Blood Disorders.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Meier
authors.affiliation: Division of Hospitalist Medicine, and.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Winer
authors.affiliation: Center for Cancer and Blood Disorders.
authors.forename: Megan
authors.initials: M
authors.lastname: Coco
authors.affiliation: Center for Clinical Resource Management, Children's National Health System, Washington, District of Columbia.
authors.forename: Mary
authors.initials: M
authors.lastname: Daymont
authors.affiliation: Center for Clinical Resource Management, Children's National Health System, Washington, District of Columbia.
authors.forename: Sierra
authors.initials: S
authors.lastname: Long
authors.affiliation: Center for Pediatric Informatics.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D010146:Pain / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult