Hospital use by pediatric patients: Implications for change

Introduction: We conducted an analysis of population-based records of hospitalizations for all children 1-12 years old in California in order to provide detailed descriptive diagnostic information on pediatric hospitalizations and to analyze differences in hospital use by population group. Methods: We analyzed 1992 computerized hospital discharge data for all children ages 1-5 years (n=76,611) and 6-12 years (n=54,827) in California acute care hospitals. We looked at the major diagnoses resulting in hospitalization and the total cost and total length of hospital stay by diagnosis. Relative risks for hospitalization by race and gender were calculated with 95% confidence intervals. Results: Discharges among children ages 1-5 years accounted for $746 million in hospital charges and 319,059 days of hospitalization while discharges among children ages 6-12 years accounted for $580 million and 310,912 hospital days. Asthma, injuries, pneumonia, gastroenteritis, and congenital disease accounted for 46% of hospitalizations in children between 1 and 5 years old. Injury, appendicitis, asthma, mental illness, and pneumonia accounted for 45% of hospitalizations in those between 6 and 12. The risk of hospitalization varied significantly by gender and race. Conclusions: Many pediatric hospitalizations are preventable, and further efforts are needed to address this problem through improved access to primary care and education. Of particular significance are the racial variations in risk of hospitalization due to asthma and mental illness.