Impact of Age on Emergency Resource Utilization and Outcomes in Pediatric and Young Adult Patients Supported with a Ventricular Assist Device

Jonathan J. Edwards, Jonathan B. Edelson, Antara Mondal, Hannah Katcoff, Nosheen Reza, Heather Griffis, Danielle S. Burstein, Carol A. Wittlieb-Weber, Matthew J. O'Connor, Joseph W. Rossano, Chitra Ravishankar, Christopher Mascio, Edo Y. Birati, Kimberly Y. Lin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

There are minimal data describing outcomes in ambulatory pediatric and young adult ventricular assist device (VAD)-supported patient populations. We performed a retrospective analysis of encounter-level data from 2006 to 2017 Nationwide Emergency Department Sample (NEDS) to compare emergency department (ED) resource utilization and outcomes for pediatric (≤18 years, n = 494) to young adult (19-29 years, n = 2,074) VAD-supported patient encounters. Pediatric encounters were more likely to have a history of congenital heart disease (11.3% vs. 4.8%). However, Pediatric encounters had lower admission/transfer rates (37.8% vs. 57.8%) and median charges ($3,334 (IQR $1,473-$19,818) vs. $13,673 ($3,331-$45,884)) (all p < 0.05). Multivariable logistic regression modeling revealed that age itself was not a predictor of admission, instead high acuity primary diagnoses and medical complexity were: (adjusted odds ratio; 95% confidence intervals): cardiac (3.0; 1.6-5.4), infection (3.4; 1.7-6.5), bleeding (3.9; 1.7-8.8), device complication (7.2; 2.7-18.9), and ≥1 chronic comorbidity (4.1; 2.5-6.7). In this largest study to date describing ED resource use and outcomes for pediatric and young adult VAD-supported patients, we found that, rather than age, high acuity presentations and comorbidities were primary drivers of clinical outcomes. Thus, reducing morbidity in this population should target comorbidities and early recognition of VAD-related complications.

Original languageEnglish
Pages (from-to)1074-1082
Number of pages9
JournalASAIO Journal
Volume68
Issue number8
DOIs
StatePublished - 1 Aug 2022

Bibliographical note

Publisher Copyright:
© 2022 ASAIO.

Funding

This study was supported by grants from NIH to JJE (5T32HL00791). N.R. is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001879. This work was supported by the Cardiac Center Clinical Research Core at the Children’s Hospital of Philadelphia.

FundersFunder number
National Institutes of Health5T32HL00791
National Center for Advancing Translational SciencesKL2TR001879

    Keywords

    • Age
    • Outcomes
    • Pediatric
    • Ventricular assist device

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