title: Hospitalization for Community-Acquired Pneumonia in Children: Effect of an Asthma Codiagnosis.
abstract: OBJECTIVE
  Community-acquired pneumonia (CAP) is a common and expensive cause of hospitalization among US children, many of whom receive a codiagnosis of acute asthma. The objective of this study was to describe demographic characteristics, cost, length of stay (LOS), and adherence to clinical guidelines among these groups and to compare health care utilization and guideline adherence between them.
  
  
  METHODS
  This was a multicenter retrospective cohort study using data from the Pediatric Health Information System. Children aged 2 to 18 who were hospitalized with uncomplicated CAP from July 1, 2007, to June 30, 2012 were included. Demographics, LOS, total standardized cost, and clinical guideline adherence were compared between patients with CAP only and CAP plus acute asthma.
  
  
  RESULTS
  Among the 25,124 admissions, 57% were diagnosed with CAP only; 43% had a codiagnosis of acute asthma. The geometric mean for standardized cost was $4830; for LOS, it was 2.01 days. Eighty-four percent of patients had chest radiographs; CAP+acute asthma patients were less likely to have a blood culture performed (36% vs 62%, respectively) and more likely not to have a complete blood count performed (49% vs 27%, respectively). Greater guideline adherence was associated with higher cost at the patient-level but lower average cost per hospitalization at the hospital level. CAP+acute asthma patients had higher relative costs (11.8%) and LOS (5.6%) within hospitals and had more cost variation across hospitals, compared with patients with CAP only.
  
  
  CONCLUSIONS
  A codiagnosis of acute asthma is common for children with CAP. This could be from misdiagnosis or co-occurrence. Diagnostic and/or management variability appears to be greater in patients with CAP+asthma, which may increase resource utilization and LOS for these patients.
authors.affiliation: Section of Pediatric Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado; Karen.wilson@childrenscolorado.org.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado; Children's Outcomes Research, University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Torok
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.affiliation: Section of Pediatric Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Lisa
authors.initials: L
authors.lastname: McLeod
authors.affiliation: Division of Pediatric Inpatient Medicine, Department of Pediatrics, Primary Children's Hospital and Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah;
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Healthcare Analytics Unit, PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.affiliation: Healthcare Analytics Unit, PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Mohamad
authors.affiliation: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology