The Roles of Infection Risk and Caretaker Education in Reducing Emergency Department Readmissions Among Pediatric Tracheostomy Patients

OBJECTIVES: To determine factors associated with frequent emergency department (ED) visits and hospitalizations among pediatric tracheostomy patients. METHODS: A longitudinal cohort of children with tracheostomies were followed for the first 24 months after index discharge. Multiple logistic regression analyses identified associated factors for frequent health care utilization (> 4 visits in 24 months). RESULTS: 239 children requiring 1285 total visits to the ED or hospital after index discharge were included, with 112 children (46.7%) having four or more visits. Respiratory-related illness was the most common indication (N=699 visits, 54%), followed by gastrostomy tube issues (N = 119, 9.3%). Variables predicting frequent utilization on regression analysis included Black race (OR = 2.01, 95% CI = 1.18 - 3.70), mechanical ventilation (OR = 2.74, 95% CI = 1.35 - 5.59), and Spanish language (OR = 3.86, 95% CI = 1.47 - 10.11). There were no predictors of visits for tracheostomy-related complications, which accounted for 4.8% of all encounters. A sub-analysis showed that Hispanic race and gestational age predicted visits for respiratory failure. CONCLUSION: 47% of pediatric tracheostomy patients necessitate frequent ED and hospital utilization in the first two years after placement. Strategies related to reducing respiratory- and gastrostomy-related admissions may have the most impact given their high frequency. The significance of primary Spanish language and mechanical ventilation may emphasize the importance of quality caretaker education prior to patient discharge.