The weekend effect on morbidity and mortality among pediatric epilepsy admissions

Publication date: Available online 2 June 2017
Source:Pediatric Neurology
Author(s): Timothy Wen, Daniel R. Kramer, Steve Sirot, Lianne Ho, Alimohammad S. Moalem, Steven Y. Cen, David Millett, Christianne Heck, R. Aaron Robison, William J. Mack, Charles Y. Liu
ObjectivePediatric epilepsy is one of the most common neurological disorders with low mortality and high morbidity, often requiring hospitalization. Weekend admissions have been shown to be associated with worse outcomes compared to their weekday counterparts. To date, no study has assessed the impact of weekend admission on clinical and quality outcomes in the pediatric epilepsy population.MethodsChildren with epilepsy were identified from the 2000, 2003, 2006, and 2009 Kids Inpatient Database. Quality outcomes were identified using the Centers of Medicare and Medicaid Services' hospital acquired conditions ICD-9CM codes. Multivariable analyses were conducted to assess the association between weekend admission and inpatient mortality and hospital acquired condition occurrence.Results526,765 pediatric epilepsy discharges were identified with 80% occurring on weekdays and 20% on weekends. Overall, the hospital acquired conditions rate was 3.6% (3.2% vs. 5.2%, weekday vs. weekend) and inpatient mortality was 1.5% (1.2% vs. 1.7%). Patients admitted on the weekend had 28% higher rates of hospital acquired conditions and 21% higher inpatient mortality rates compared to their weekday counterparts. Patients seen at non-pediatric centers had 10-28% lower rates of mortality, but 5-13% higher hospital acquired conditions rates than those at pediatric centers.SignificanceWeekend admission is significantly associated with worse clinical and quality outcomes compared to weekday admits among pediatric epilepsy inpatients. Weekend admissions likely represent unplanned, at risk admissions, coupled with under- or inexperienced staffing. Further study is needed to isolate clinical and systemic factors to decrease this disparity in this highly comorbid pediatric subgroup.



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