What Conditions Are Sending Kids to the Hospital?

The most common pediatric diagnoses in U.S. hospitals were bronchiolitis, pneumonia, and asthma, according to a cross-sectional analysis of 2016 data, and they also proved to be the most costly.

An analysis of the Kids’ Inpatient Database (KID) showed that there were nearly 100,000 hospitalizations for acute bronchiolitis in 2016, and the majority of those hospitalizations occurred in urban teaching hospitals (n=51,642), reported Sunitha Kaiser, MD, MSc, of the University of California San Francisco, and colleagues.

For both pneumonia and asthma, there were over 80,000 hospitalizations identified in the all-payer, administrative data set, they wrote in a JAMA Pediatrics research letter.

These three conditions were also among the costliest diagnoses, with pediatric pneumonia coming in second at $785 million, bronchiolitis fourth at $702 million, and asthma eighth at $452 million. The costliest diagnosis was respiratory failure, totaling nearly $1 billion in a year, according to the authors, who explained that they “grouped primary diagnoses using the Pediatric Clinical Classification System codes and rank-ordered total prevalence and cost by hospital type.”

“We believe these findings help guide the selection of high-priority diagnoses for pediatric research and quality improvement efforts that would make the greatest impact for children across the U.S.,” they stated.

The findings follow those from an October 2021 study that questioned the growing costs associated with changes in bronchiolitis care practices. From 2010 to 2019, the median standardized unit cost per bronchiolitis hospitalization among children, ages 2 years or younger, increased by over $1,000, according to that study.

Kaiser’s also found that the number of diagnoses of major depressive order shot up to nearly 80,000 in 2016 from approximately 29,000 in 2012. It became the fourth most common diagnosis among children, joining bronchiolitis, pneumonia, and asthma as a condition that was both high in prevalence and cost, they said. Major depressive disorder was also more commonly diagnosed outside of freestanding children’s hospitals, the authors added.

“Recent data suggested that additional increases in mental health hospitalizations were associated with the COVID-19 pandemic,” Kaiser and colleagues wrote, citing an April 2021 study on increased emergency department visits for mental health conditions in 2020.

“These findings reinforce the need to identify effective interventions for children who are hospitalized with mental health disorders,” they said.

The majority of all hospitalizations occurred in urban hospitals, with only 4.4% of hospitalizations happening in rural hospitals. Most pediatric hospitalizations happened outside of freestanding children’s hospitals.

Chemotherapy, seizures, and respiratory failure were more prevalent diagnoses in freestanding children’s hospitals (ranking 3, 5, and 7, respectively) versus outside of children’s hospitals. Both chemotherapy and respiratory failure were less common diagnoses in rural hospitals and urban nonteaching hospitals, according to the authors.

From their analysis of KID, Kaiser’s group estimated 1.7 million non-birth hospital discharges for children ages 0 to 17. Data were excluded if primary diagnosis or cost were missing (n=32,310, 1.2%).

Non-birth, pediatric hospitalizations broke down as follows by age:

• <1 years: 447,906 hospitalizations (25.3%)
• 1-4 years: 377,887 hospitalizations (21.3%)
• 5-12 years:448,666 hospitalizations (25.3%)
• 13-17 years: 495,563 hospitalizations (28.0%)

Almost half (48.8%) of children hospitalized were female and non-Hispanic white (44.8%). Most children who were hospitalized had one or more chronic conditions, and children from communities with below average median incomes were more likely to be hospitalized, the authors reported.

Study limitations included the use of 2016 data so the findings may not reflect the current pediatric healthcare environment, Kaiser and colleagues explained. Also, instances in which a single patient was hospitalized multiple times could not be identified from the KID data, which only records discharges, they stated.