Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.

Awareness about thalassemia and feasibility of cascade screening in families of thalassemia major patients

Background: The main objective of this study is to assess knowledge and attitude of parents & extended relatives of children diagnosed with Thalassemia major and to evaluate feasibility of screening of extended families for thalassemia trait by correlating their willingness to get screened with actual screening.Methods: This was a cross sectional type of descriptive' analytical study, conducted at the thalassemia day care center at a tertiary care teaching hospital in western India among 230 study population using a pre-designed and pre-validated structured questionnaire.Results: We found the overall knowledge score of parents about thalassemia was significantly better than relatives. About 95.83% of parents and only 31.86% of the relatives amongst the study population had adequate knowledge. Majority of study population (84.61% relatives and 100% parents) had positive attitude. The significant contributing factors for knowledge and attitude towards thalassemia were age, marital status, education level, religion and per capita monthly income. 2% relatives agreed to get themselves screened for thalassemia status out of which only 20% got themselves screened.Conclusions: This study has identified key areas which need to be highlighted and emphasized in public awareness campaigns for thalassemia screening in India.

Urinary Bladder Endometriosis.

Endometriosis is characterized by the presence of endometrial tissue in the ectopic foci outside the uterus.Usual sites of its occurence are ovaries, uterine ligaments, fallopian tubes, rectum and cervico-vaginal regions. Urinary tract is a rare site of occurence and accounts for 1-2% cases.84% of cases in urinary tract occur in urinary bladder. We report a case of urinary bladder endometriosis in a 35 years old female patient who presented with cyclical pain and hematuria with a mass in right posterolateral wall of the urinary bladder.

Biotinidase deficiency.

A three month old baby presented with refractory seizures, dermatosis and persistent metabolic acidosis. Biotinidase deficiency was diagnosed on enzyme assay. Patient responded dramatically to biotin supplementation.