Dataset Information

Identifying Long-Term Morbidities and Health Trajectories After Prolonged Mechanical Ventilation in Children Using State All Payer Claims Data.

ABSTRACT:

Objectives

To identify postdischarge outcome phenotypes and risk factors for poor outcomes using insurance claims data.

Design

Retrospective cohort study.

Setting

Single quaternary center.

Patients

Children without preexisting tracheostomy who required greater than or equal to 3 days of invasive mechanical ventilation, survived the hospitalization, and had postdischarge insurance eligibility in Colorado's All Payer Claims Database.

Interventions

None.

Measurements and main results

We used unsupervised machine learning to identify functional outcome phenotypes based on claims data representative of postdischarge morbidities. We assessed health trajectory by comparing change in the number of insurance claims between quarters 1 and 4 of the postdischarge year. Regression analyses identified variables associated with unfavorable outcomes. The 381 subjects had median age 3.3 years (interquartile range, 0.9-12 yr), and 147 (39%) had a complex chronic condition. Primary diagnoses were respiratory (41%), injury (23%), and neurologic (11%). We identified three phenotypes: lower morbidity (n = 300), higher morbidity (n = 62), and 1-year nonsurvivors (n = 19). Complex chronic conditions most strongly predicted the nonsurvivor phenotype. Longer PICU stays and tracheostomy placement most strongly predicted the higher morbidity phenotype. Patients with high but improving postdischarge resource use were differentiated by high illness severity and long PICU stays. Patients with persistently high or increasing resource use were differentiated by complex chronic conditions and tracheostomy placement.

Conclusions

New morbidities are common after prolonged mechanical ventilation. Identifying phenotypes at high risk of postdischarge morbidity may facilitate prognostic enrichment in clinical trials.

SUBMITTER: Maddux AB

PROVIDER: S-EPMC9058185 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Identifying Long-Term Morbidities and Health Trajectories After Prolonged Mechanical Ventilation in Children Using State All Payer Claims Data.

Maddux Aline B AB Mourani Peter M PM Miller Kristen K Carpenter Todd C TC LaVelle Jaime J Pyle Laura L LL Watson R Scott RS Bennett Tellen D TD

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20220307 4

<h4>Objectives</h4>To identify postdischarge outcome phenotypes and risk factors for poor outcomes using insurance claims data.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Single quaternary center.<h4>Patients</h4>Children without preexisting tracheostomy who required greater than or equal to 3 days of invasive mechanical ventilation, survived the hospitalization, and had postdischarge insurance eligibility in Colorado's All Payer Claims Database.<h4>Interventions</h4>None.<h4>Measu ...[more]

PMID: 35250002

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Dataset Information

Identifying Long-Term Morbidities and Health Trajectories After Prolonged Mechanical Ventilation in Children Using State All Payer Claims Data.

Objectives

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

Identifying Long-Term Morbidities and Health Trajectories After Prolonged Mechanical Ventilation in Children Using State All Payer Claims Data.

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