The Top Reasons for Pediatric Hospital Stays? Mental Health, Teen Pregnancy

Van Horne B, Netherton E, Helton J, Fu M, Greeley C. The scope and trends of pediatric hospitalizations in Texas, 2004–2010. Hosp Pediatr. 2015;5(7):390-398.

Examining the demographics and trends of the diseases and conditions that lead to pediatric hospital stays can reveal wider implications for the care of children, especially when the cost of these inpatient stays also is studied. To that end, a longitudinal, retrospective, cross-sectional study using data on hospitalized children in Texas recently was published.

Pediatric hospitalization trends in Texas have a number of particularly fascinating aspects. The pediatric population of the state is more than 7.4 million—in fact, 1 in 10 U.S. children live in Texas. The racial and ethnic composition of Texas (35% white, 44% Hispanic, 12% African American) is similar to the projected diversity of the United States in 2050. Texas also has very high rates of children without health insurance (as many as 18%) and those living in poverty (as many as 27%).

Hospital discharge data from 2004 to 2010 were compiled from the Texas Hospital Inpatient Public Use Data File, which contains data on discharges from all Texas hospitals since 1999. Data were categorized by diagnosis-related groups (DRGs) and major diagnostic categories (MDCs). Each MDC corresponded to an organ system, allowing examination of broad trends in diseases and costs associated with hospitalization.

The authors analyzed statistics on demographics, discharge diagnoses, and costs and estimated the rate change and 95% confidence intervals over the study period. A detailed cost analysis looked at bill types, the specific hospital Medicare cost reports for the period, and total billed fees, and then transformed this cost estimate into 2010 dollars using U.S. Bureau of Labor Statistics medical cost inflation indexes for Texas.

From 2004 to 2010, Texas averaged 591,571 pediatric hospitalizations annually. Birth was the most common reason for hospitalization, representing 64% of all stays each year. Respiratory illness was the most common cause of hospitalization in children aged 1 month to 9 years, although a 2% decrease occurred over the study period. The most common reason for hospitalization of children aged 10 to 14 years was mental disorders, accounting for 30% of stays in this age group—a rate that increased 2.5% over the study period. Pregnancy, childbirth, and puberty-related conditions were the most common cause of hospitalizations for teens aged 15 to 17 years, at 39%.

The 1-month-old to 1-year-old age group represented the largest cost driver for hospitalizations, incurring $1.1 billion in adjusted costs each year. On average, healthy newborns represented 88% of all neonatal hospitalizations but only 40% of the expense, since much of the cost was devoted to newborns hospitalized for neonatal complications. Developing strategies to limit even a small number of these admissions would lead to significant cost reduction, the authors wrote.

Perhaps the most striking observations are that mental health is the most common reason for hospitalization in preteens (10-14 years) and the second most common reason in adolescents (15-17 years), and that pregnancy/childbirth is the most common reason for hospitalization in 15- to 17-year-olds. This reinforces the importance of mental health care among adolescents, since pediatric hospitalizations for mental diseases and disorders demonstrated the largest rate increase of any MDC in the study. The high rate of adolescent hospitalizations for childbirth likely is related in part to the high number of teen pregnancies in Texas (25.6 per 1,000 girls aged 15 to 19, compared with the national average of 15.4 per 1,000).

This study’s observations and conclusions about inpatient hospitalization data appear to reflect a need for greater support for outpatient primary care structures in the creation of a comprehensive medical home for children.

Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.