title: Care Variations and Outcomes for Children Hospitalized With Bacterial Tracheostomy-Associated Respiratory Infections.
abstract: Identify hospital-level care variations and association with length of stay (LOS) and hospital revisit in children with tracheostomies hospitalized for bacterial respiratory tract infections (bRTIs).
  
  
  
  A multicenter, retrospective cohort study that used the Pediatric Health Information System database between 2007 and 2014 of patients with tracheostomies aged ≤18 years with a primary diagnosis of bRTI (eg, tracheitis) or a primary diagnosis of a bRTI symptom (eg, cough) and a secondary diagnosis of bRTI. Primary outcomes were LOS and 30-day all-cause revisit rates. Secondary outcomes included hospital-level diagnostic testing and anti-Pseudomonas antibiotic use. We used mixed-effects negative binomial (for LOS) and logistic (for revisit) regression to explore the relationship between hospital-level diagnostic test utilization and the outcomes.
  
  
  
  Data representing 4137 unique patients with a median age of 3 years (interquartile range: 1-9 years) were included. Median LOS was 4 days (interquartile range: 3-8 days), and the 30-day revisit rate was 24.9%. Use of diagnostic testing and empirical anti-Pseudomonas antibiotics varied significantly among hospitals (all P values <.001). After adjusting for patient and hospital characteristics, compared with low test utilization hospitals, there were no differences in 30-day all-cause revisit rates in moderate (adjusted odds ratio: 1.19; 95% confidence interval [CI]: 0.93-1.52) or high (adjusted odds ratio: 1.07; 95% CI: 0.82-1.39) utilization hospitals. LOS in hospitals with moderate (% difference: -0.8%; 95% CI: -14.4-14.9%) or high (% difference: 13.9%; 95% CI: -0.7-30.6%) test utilization was not significantly longer.
  
  
  
  Given that care variations were not associated with outcomes, future research should focus on standardizing diagnosis and treatment of bRTIs and readmission prevention in this population.
authors.affiliation: Department of Pediatrics and crussell@chla.usc.edu.|Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Russell
authors.affiliation: Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.affiliation: Department of Pediatrics and.|Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Wu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000379:methods / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents