title: Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment.
abstract: OBJECTIVE
  Children with neurologic impairment (NI) are commonly hospitalized for different types of pneumonia, including aspiration pneumonia. We sought to compare hospital management and outcomes of children with NI diagnosed with aspiration versus nonaspiration pneumonia.
  
  
  METHODS
  A retrospective study of 27 455 hospitalized children aged 1 to 18 years with NI diagnosed with pneumonia from 2007 to 2012 at 40 children's hospitals in the Pediatric Health Information System database. The primary exposure was pneumonia type, classified as aspiration or nonaspiration. Outcomes were complications (eg, acute respiratory failure) and hospital utilization (eg, length of stay, 30-day readmission). Multivariable regression was used to assess the association between pneumonia type and outcomes, adjusting for NI type, comorbid conditions, and other characteristics.
  
  
  RESULTS
  In multivariable analysis, the 9.7% of children diagnosed with aspiration pneumonia experienced more complications than children with nonaspiration pneumonia (34.0% vs 15.2%, adjusted odds ratio [aOR] 1.2 (95% confidence interval [CI] 1.1-1.3). Children with aspiration pneumonia had significantly longer length of stay (median 5 vs 3 days; ratio of means 1.2; 95% CI 1.2-1.3); more ICU transfers (4.3% vs 1.5%; aOR 1.4; 95% CI 1.1-1.9); greater hospitalization costs (median $11 594 vs $5162; ratio of means 1.2; 95% CI 1.2-1.3); and more 30-day readmissions (17.4% vs 6.8%; aOR 1.3; 95% CI 1.2-1.5).
  
  
  CONCLUSIONS
  Hospitalized children with NI diagnosed with aspiration pneumonia have more complications and use more hospital resources than when diagnosed with nonaspiration pneumonia. Additional investigation is needed to understand the reasons for these differences.
authors.affiliation: Divisions of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; joanna.thomson@cchmc.org.
authors.forename: Joanna
authors.initials: J
authors.lastname: Thomson
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Divisions of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Biostatistics and Epidemiology, and.
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.affiliation: Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, Utah; Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah;
authors.forename: Bryan
authors.initials: B
authors.lastname: Stone
authors.affiliation: Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, Utah; Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah; Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah;
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Divisions of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000150:complications*; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors