Publications by authors named "Lauren C Rakes"

3 Publications

  • Page 1 of 1

Resources and Costs Associated With Repeated Admissions to PICUs.

Crit Care Explor 2021 Feb 17;3(2):e0347. Epub 2021 Feb 17.

Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge.

Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System.

Setting: Fifty-two tertiary children's hospitals.

Subjects: Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017.

Interventions: None.

Measurements And Main Results: Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75-0.89]; < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36-1.51]; < 0.001).

Conclusions: Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children's hospitals.
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February 2021

Prevention of emergence agitation in seven children receiving low-dose ketamine and propofol total intravenous anesthesia.

AANA J 2011 Jun;79(3):238-42

Pain Management Service, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Emergence agitation (EA) can be a distressing side effect of pediatric anesthesia. We retrospectively reviewed the records of 7 pediatric oncology patients who received low-dose ketamine in conjunction with propofol for total intravenous anesthesia (TIVA) repeatedly for radiation therapy. EA signs were observed in all 7 patients in association with propofol TIVA but did not recur in any of 123 subsequent anesthetics sessions during which low-dose ketamine was added to propofol. Based on this experience, we suggest that low-dose ketamine added to propofol may be associated with prevention of EA in children with a history of EA with propofol TIVA.
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June 2011

Clostridium difficile-associated disease in allogeneic hematopoietic stem-cell transplant recipients: risk associations, protective associations, and outcomes.

Clin Transplant 2010 Mar-Apr;24(2):192-8. Epub 2009 Jul 13.

Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

The purpose of this study was to evaluate risk factors, protective factors, and outcomes associated with Clostridium difficile-associated disease (CDAD) in allogeneic hematopoietic stem-cell transplant (HSCT) recipients. A case-control study was performed with 37 CDAD cases and 67 controls. In the multivariable logistic regression analysis, receipt of a third or fourth generation cephalosporin was associated with increased risk of CDAD (OR = 4.6, 95% CI 1.6-13.1). Receipt of growth factors was associated with decreased risk of CDAD (OR=0.1, 95% CI 0.02-0.3). Cases were more likely to develop a blood stream infection after CDAD than were controls at any point before discharge (p < 0.001). CDAD cases were more likely than controls to develop new onset graft-vs.-host disease (GVHD) (p < 0.001), new onset severe GVHD (p < 0.001), or new onset gut GVHD (p = 0.007) after CDAD/discharge. Severe CDAD was a risk factor for death at 180 d in multivariable Cox proportional hazards regression (HR=2.6, 95% CI 1.1-6.2). CDAD is a significant cause of morbidity and mortality in allogeneic HSCT patients, but modifiable risk factors exist. Further study is needed to determine the best methods of decreasing patients' risk of CDAD.
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August 2010