Neurologic conditions represent a large proportion of pediatric readmissions.  It is unclear to what extent these unplanned readmissions can be attributed to preventable issues (e.g. medical error, suboptimal care) or to the expected course of refractory and/or chronic medical conditions.  Identifying who is at risk for readmission is necessary to identify avoidable readmissions, improve the transition of inpatient to outpatient care, and control rising health care costs.

Hospital readmission is an important quality improvement measure that has not been well studied in pediatric neurology.  We examined predictors of 7-day and 30-day readmissions for pediatric patients hospitalized with a neurological diagnosis.

This was a retrospective study of hospital readmission rates in pediatric neurology patients admitted to a tertiary children’s hospital from 01/2017-12/2017.  Inclusion criteria were age ≤18 years, a primary neurological diagnosis on admission, and an unplanned readmission within 7 or 30 days. Demographic and clinical data were collected, including age, gender, income, insurance type, discharge occurring on a weekend, PICU admission, use of multiple AEDs, and involvement of multiple subspecialties.

There were 923 neurology admissions, and 64 readmissions within 30 days. Total unplanned readmission rate was 6.9%, with 56% (36/64) readmitted within 30 days, 44% (28/64) readmitted within 7 days, and 11% (7/64) admitted multiple times within 30 days. The most common readmission diagnosis was seizure (62%), followed by other neurological diagnosis (21%), headache (8%), encephalitis/meningitis (7%), stroke(1%), and ataxia (1%).  Readmission was significantly associated with multiple AED, PICU admission, seizure with major complication/comorbidity, and presence of a major complication/comorbidity irrespective of diagnosis (p<0.05).

This is the first known study to identify factors associated with higher rates of readmission in pediatric neurology. Patients with epilepsy and chronic neurological conditions should be targeted for future discharge-related interventions to reduce hospital readmission and ensure safe transitions from the inpatient to outpatient setting.