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Original Article | ONLINE FIRST

Socioeconomic Implications of Pediatric Cervical Methicillin-Resistant Staphylococcus aureus Infections

Michael E. McCormick, MD; Robert H. Chun, MD; Lina Lander, ScD; Rahul K. Shah, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(2):124-128. doi:10.1001/jamaoto.2013.1234.
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Objective  To study cervical methicillin-resistant Staphylococcus aureus (MRSA) infections using a national database with the goal of providing normative data and identifying variations in resource utilization.

Design  Retrospective review using a pediatric national data set (Kids' Inpatient Database 2009).

Subjects  Inclusion criteria were admissions with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for both MRSA and specific neck and pharyngeal infections.

Results  There were 26 829 admissions with MRSA; 3571 included a head and neck infection. The mean (SE) age at admission was 7.72 (0.20) years. Most patients (65.0%) were in the lower 2 socioeconomic quartiles; the most common payer was Medicaid (53.3%). The mean total charge per admission was $20 442. The mean (SE) length of stay (LOS) was 4.39 (0.15) days; there were significant differences among age (P < .001) and racial (P < .001) groups. A total of 1671 children underwent at least 1 surgical drainage procedure; there were statistically significant differences among racial (P < .001), age (P < .001), and socioeconomic (P = .048) groups. There were no regional variations in resource utilization when LOS, number of procedures, and total hospital charges were compared.

Conclusions  Cervical MRSA infections have a large socioeconomic impact across the nation. There are differences among the various races in resource utilization. Younger children have longer hospitalizations, are more likely to need surgery, and require more intubations. Children from the lowest socioeconomic group require surgery more frequently, but their LOS is not statistically different when compared with the other 3 groups. Knowledge of such characteristics for cervical MRSA infections in children can facilitate targeted clinical interventions to improve care of affected populations.

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Figure 1. Regional variation in resource utilization. There were no regional variations in length of stay, number of surgical drainage procedures, and total hospital charges. While the values are not significant, patients in the West region had longer hospitalizations (P = .81), more surgery (P = .54), and higher total charges (P = .14). The following states are not included in the Kids' Inpatient Database 2009: Alabama, Alaska, Delaware, Idaho, Mississippi, and North Dakota.

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Figure 2. Length of stay vs age, race, and socioeconomic status. Longer hospitalizations were found in children younger than 3 years (P < .001) and nonwhite children (P < .001). The length of stay did not vary among socioeconomic groups (P = .12). The error bars represent the standard error.

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Grahic Jump Location

Figure 3. Surgical drainage vs age, race, and socioeconomic status. Surgical drainage was needed more frequently in younger children (P < .001), nonwhite children (P < .001), and children from areas with the lowest median household income (P = .048).

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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