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Risk factors associated with paediatric unplanned hospital readmissions: a systematic review
  1. Huaqiong Zhou1,2,
  2. Pam A Roberts2,
  3. Satvinder S Dhaliwal3,
  4. Phillip R Della2
  1. 1 General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia
  2. 2 School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
  3. 3 School of Public Health, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Professor Phillip R Della; P.Della{at}curtin.edu.au

Abstract

Objective To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs).

Design Systematic review.

Data source CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017.

Eligibility criteria Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included.

Data extraction and synthesis Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form.

Results Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS.

Conclusions This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13–18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.

  • risk management
  • paediatrics

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Footnotes

  • Patient consent for publication Not required.

  • Contributors HZ conceptualised and designed the systematic review, participated in literature search, paper selection, critical appraisal and data analyses, drafted the initial manuscript and approved the final manuscript as submitted. PAR contributed in the paper selection and data extraction, critical appraisal and initial analyses, critically reviewed the manuscript and approved the final manuscript as submitted. SSD contributed in the paper selection and data extraction, critical appraisal and initial analyses, critically reviewed the manuscript and approved the final manuscript as submitted. PRD conceptualised and designed the systematic review, participated in the paper selection, data extraction, critical appraisal and data analyses, critically reviewed the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding All phases of this study were supported by a grant from the Australian Research Council— ARC Linkage Grant (Project ID: LP140100563). HZ is also supported by the Academic Support Grant 2016 & the Academic Research Grant 2014 from the Nursing and Midwifery office, Western Australian Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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