Mexican Americans Receive Less Intensive Stroke Rehabilitation Than Non-Hispanic Whites.

BACKGROUND AND PURPOSE: Mexican Americans (MAs) have worse neurological, functional, and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine whether allocation of stroke rehabilitation services differed by ethnicity. METHODS: Patients with stroke were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, TX, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for 3 months after stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using 2 sample t tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using χ2 tests. Ethnic comparisons of rehabilitation services were compared using χ2 tests, Fisher's exact tests, and logistic regression. RESULTS: Seventy-two subjects (50 MA and 22 non-Hispanic white [NHW]) were followed. Mean age, NHW-69 (SD 13), MA-66 (SD 11) years, sex (NHW 55% male, MA 50% male) and median presenting National Institutes of Health Stroke Scale did not differ significantly. There were no ethnic differences among the proportion of patients who were sent home without any rehabilitation services (P=0.9). Among those who received rehabilitation, NHWs were more likely to get inpatient rehabilitation (73%) compared with MAs (30%), P=0.016. MAs (51%) were much more likely to receive home rehabilitation services compared with NHWs (0%) (P=0.0017). CONCLUSIONS: In this population-based study, MAs were more likely to receive home-based rehabilitation, whereas NHWs were more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes.

OBJECTIVES: To determine if gestational age (GA) is independently associated with hospital resource use and outcomes among infants hospitalized for respiratory syncytial virus (RSV). STUDY DESIGN: Analysis of retrospective data from 304 infants ( or =37 weeks) and 89 infants with GA <37 weeks, divided according to GA into 3 subgroups (< or =32, 33 to 35, and 36 weeks), were compared. Significant differences were found for rate of intubation (P=.002) and ICU and hospital length of stay (P=.021 and P<.0001, respectively), with the highest resource use in 33 to 35 weeks GA infants, which remained significant in multiple regression analyses. CONCLUSIONS: Infants 33 to 35 weeks GA had hospital outcomes that were negative or worse than infants < or =32 weeks GA. Data suggest prematurity < or =35 weeks GA significantly increases the risk for severe outcomes among infants hospitalized for RSV. Infants 36 weeks GA had outcomes similar to term infants. No evidence was observed of gradation or inverse linear risk relation between GA and hospital outcomes.

Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia.

OBJECTIVE: To characterize complications among infants hospitalized for bronchiolitis or respiratory syncytial virus (RSV). STUDY DESIGN: Retrospective data from 684 infants with bronchiolitis or RSV pneumonia, < or =1 year old, admitted to 10 children's hospitals from April 1995 to September 1996. Outcomes included complication rates and effects on hospital and pediatric intensive care unit (PICU) length of stay (LOS) and hospital costs. RESULTS: Most infants (79%) had one or more complication, with serious complications in 24%. Even minor complications were associated with significantly longer PICU and hospital LOS and higher costs (P<.001). Respiratory complications were most frequent (60%), but infectious (41%), cardiovascular (9%), electrolyte imbalance (19%), and other complications (9%) were common. Complication rates were higher in former premature infants (87%), infants with congenital heart disease (93%), and infants with other congenital abnormalities (90%) relative to infants without risk factors (76%). Infants 33 to 35 weeks gestational age (GA) had the highest complication rates (93%), longer hospital LOS, and higher costs (P<.004) than other former premature infants. CONCLUSIONS: Complications were common in infants hospitalized for bronchiolitis or RSV pneumonia and were associated with longer LOS and higher costs. Former premature infants and infants with congenital abnormalities are at significantly greater risk for complications. Broader use of RSV prevention should be considered for these higher-risk infants.

Development of a pediatric age- and disease-specific severity measure.

OBJECTIVES: To adapt the adult Comprehensive Severity Index (CSI) for hospitalized pediatric patients and evaluate the ability of the CSI to predict common outcomes. STUDY DESIGN: Adult CSI was modified by a panel of pediatric subspecialists from 10 children's hospitals. Predictive power was evaluated by using retrospective data collected from 16,495 randomly selected children admitted to these hospitals from April 1995 through September 1996. Outcomes were mortality, length of stay (LOS), and cost. RESULTS: Admission CSI score predicted mortality well (Hosmer-Lemeshow tests: P =.41-.98) and discriminated well (area under receiver operating characteristic [ROC] curve range = 0.80-0.99) within 9 case-mix groups with > or =10 deaths (P <.0001). Maximum CSI score explained the variation in LOS (r2 = 0.13-0.67) and cost (r2 = 0.08-0.73) within 32 case-mix groups (P <.005). Significant differences existed in admission and maximum average CSI scores across sites in 26 and 29 of 32 case-mix groups, respectively (P <.05). CSI had better predictability than Pediatric Risk of Mortality. CONCLUSIONS: The age- and disease-specific pediatric CSI score correlates highly with LOS, cost, and mortality in hospitalized children and can help determine the best clinical practices for specific diseases and adjust for differences in severity of illness across providers.