Article: Steuart R, Tan R, Melink K, et al. Discharge Before Return to Respiratory Baseline in Children with Neurologic Impairment. J. Hosp. Med 2020;9;531-537. doi:10.12788/jhm.3394
Fellow: Baila Harris, MD, Helen DeVos Children's Hospital/Spectrum Health
Brief Summary: Acute respiratory illness is the most common reason for admission for children with neurologic impairment. They are often discharged before return to their respiratory baseline, as they require a long recovery period. This study looked at 632 hospitalizations of children with neurologic impairment and compared the 30 day hospital reutilization of those discharged either at their respiratory baseline or before returning to baseline. There was no significant difference in reutilization between the two groups. The study did note those discharged before returning to their baseline were more complex (had chronic conditions, technology dependence, and baseline respiratory support needs) and had greater illness severity.
Article Strengths: This was a large study using the PHIS database and local EMR with a near perfect interrater reliability of k=0.97. They described important clinical details of the patients to understand their illness severity prior to discharge and which patients were discharged before returning to baseline. This allowed easier applicability of results to clinical practice. The authors chose an appropriate primary outcome measure of 30 day hospital reutilization and more specific secondary outcome of hospital reutilization for acute respiratory illness, as well as length of stay.
Limitations: Because the data was collected via retrospective chart review, there could be confounders that affected results. There was also potential intervention bias as the interventions were not discussed and could have significantly affected illness course and severity, thereby affecting discharge decisions.
Major Takeaway: Patients with neurologic impairment who were discharged before return to respiratory baseline, despite greater complexity & illness severity, did not have increased 30 day hospital reutilization.
Impact on Practice: While there were not specific criteria included for when to discharge neurologically impaired children prior to return to respiratory baseline, this article does support the notion that these patients can safely be discharged prior to return to said baseline. It stresses the importance of having a clear discharge plan for these patients when they are discharged prior to return to respiratory baseline, which while always important, should be something given particular attention in this scenario.
Fellow: Baila Harris, MD, Helen DeVos Children's Hospital/Spectrum Health
Brief Summary: Acute respiratory illness is the most common reason for admission for children with neurologic impairment. They are often discharged before return to their respiratory baseline, as they require a long recovery period. This study looked at 632 hospitalizations of children with neurologic impairment and compared the 30 day hospital reutilization of those discharged either at their respiratory baseline or before returning to baseline. There was no significant difference in reutilization between the two groups. The study did note those discharged before returning to their baseline were more complex (had chronic conditions, technology dependence, and baseline respiratory support needs) and had greater illness severity.
Article Strengths: This was a large study using the PHIS database and local EMR with a near perfect interrater reliability of k=0.97. They described important clinical details of the patients to understand their illness severity prior to discharge and which patients were discharged before returning to baseline. This allowed easier applicability of results to clinical practice. The authors chose an appropriate primary outcome measure of 30 day hospital reutilization and more specific secondary outcome of hospital reutilization for acute respiratory illness, as well as length of stay.
Limitations: Because the data was collected via retrospective chart review, there could be confounders that affected results. There was also potential intervention bias as the interventions were not discussed and could have significantly affected illness course and severity, thereby affecting discharge decisions.
Major Takeaway: Patients with neurologic impairment who were discharged before return to respiratory baseline, despite greater complexity & illness severity, did not have increased 30 day hospital reutilization.
Impact on Practice: While there were not specific criteria included for when to discharge neurologically impaired children prior to return to respiratory baseline, this article does support the notion that these patients can safely be discharged prior to return to said baseline. It stresses the importance of having a clear discharge plan for these patients when they are discharged prior to return to respiratory baseline, which while always important, should be something given particular attention in this scenario.