The last 15 years have seen tremendous advances in the care of HIV‐infected children. Kourtis et al. documented a 71% decline in pebiatric hospitalizations due to HIV from 1994 through 2003, especially after the advent of HAART. The decrease was more in children < 5 years old (61% to 17% of admissions) and boys (49% to 40%). LOS decreased and charges increased. More recent data sets are now available to evaluate if these trends have continued. The objective was to examine continued trends in pediatric HIV hospitalizations.
The Kids' Inpatient Database (KID) and Nationwide Inpatient Sample (NIS). national data sets available through AHRQ, were examined from 2003 to 2007 through HCUPnet. NIS data are annual, and KID data are triennial (2003 and 2006). Hospitalization rates for Clinical Classifications Software category 5, HIV infection, as a primary diagnosis (1DX) and all‐listed diagnosis (ALDX) were examined for trends across years. Changes in length of stay (LOS) and costs were also examined.
Admissions for HIV declined from 2003 as 1DX by 32% in the 2006 KID and 47% in the 2007 NIS, with a lower decrease as ALDX (23% 2006 KID and 38% 2007 NIS). KID data show the decreased admissions were more from children > 4 (24% by 1DX and 33% by ALDX vs. 17% and 15% for < 5). Boys represented 38% of 1DX in both the 2003 KID and NIS and 44% in the 200S KID and 2007 NIS. For ALDX the male percentage increased from 42% 2003 KID to 45% 2006 KID and from 43% 2003 NIS to 45% 2007 NIS. For all years HIV children were hospitalized overwhelmingly in teaching hospitals (> 81%) and in metropolitan areas (> 98%). LOS as 1DX has varied from 10.8 days in the 2003 NIS to 6.6 days in the 2005 NIS to 12.2 days in the 2007 NIS. Average cost per admission increased from $15,015 in the 2003 KID to $20,936 in 2006 and from $18,493 in the 2003 NIS to $20,832 in the 2007 NIS with a low of $13,448 in the 2005 NIS. Cost per day increased from $1706 in the 2003 KID to $1869 in the 2006 KID but stayed stable at $1712 in the 2003 NIS and $1707 in 2007 NIS.
Pediatric HIV admissions continue to decline, although the rate of decline has diminished and has been mostly in older children. The dramatic decrease in young children admissions has plateaued. The decrease in male admissions has also reversed, and the male/female ratio now approaches 50%. Care of HIV‐positive children on inpatient units is becoming increasingly uncommon and concentrated in teaching hospitals and metropolitan areas. LOS has not continued to decrease but has varied greatly. Costs may be increasing slightly but seem more related to LOS issues.
D. Rauch, Baxter, consultant.
To cite this abstract:Rauch D. Trends in Pediatric HIV Hospitalizations. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 122. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/trends-in-pediatric-hiv-hospitalizations/. Accessed April 26, 2019.