Disease and economic burden of infections in hospitalised children in New South Wales, Australia
Brendan J. McMullan![https://orcid.org/0000-0001-5144-3416](/media/client/orcid_16x16.png)
A School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia.
B Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia.
C National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
D Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic., Australia.
E School of Public Health, University of Queensland, Brisbane, Qld, Australia.
F National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Melbourne, Vic., Australia.
Australian Health Review 46(4) 471-477 https://doi.org/10.1071/AH21360
Submitted: 24 November 2021 Accepted: 10 May 2022 Published: 7 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objectives To describe the burden of disease and hospitalisation costs in children with common infections using statewide administrative data.
Methods We analysed hospitalisation prevalence and costs for 10 infections: appendicitis, cellulitis, cervical lymphadenitis, meningitis, osteomyelitis, pneumonia, pyelonephritis, sepsis, septic arthritis, and urinary tract infections in children aged <18 years admitted to hospital within New South Wales, Australia, using an activity-based management administrative dataset over three financial years (1 July 2016–30 June 2019).
Results Among 339 077 admissions, 28 748 (8.48%) were coded with one of the 10 infections, associated with a total hospitalisation cost of AUD230 905 190 and a per episode median length-of-stay of 3 bed-days. Pneumonia was the most prevalent coded infection (3.1% [n = 10 524] of all admissions), followed by appendicitis (1.61%; n = 5460), cellulitis (1.22%; n = 4126) and urinary tract infections (0.94%; n = 3193). Eighty per cent of children (n = 22 529) were admitted to a non-paediatric hospital. Mean costs were increased 1.18-fold per additional bed-day, 2.14-fold with paediatric hospital admissions, and 5.49-fold with intensive care unit admissions, which were both also associated with greater total bed-day occupancy. Indigenous children comprised 9.7% of children admitted with these infections, and mean per episode costs, and median bed-days were reduced compared with non-Indigenous children (0.84 [95% CI 0.78, 0.89] and 3 (IQR: 2,5) vs 2 (IQR: 2,4), respectively.
Conclusions Infections in children requiring hospitalisation contribute a substantial burden of disease and cost to the community. This varies by infection, facility type, and patient demographics, and this information should be used to inform and prioritise programs to improve care for children.
Keywords: activity based management, Australia, child, costs, economics, epidemiology, hospital, infections.
References
[1] Al-Mahtot M, Barwise-Munro R, Wilson P, Turner S. Changing characteristics of hospital admissions but not the children admitted-a whole population study between 2000 and 2013. Eur J Pediatr 2018; 177 381–8.| Changing characteristics of hospital admissions but not the children admitted-a whole population study between 2000 and 2013.Crossref | GoogleScholarGoogle Scholar | 29260375PubMed |
[2] Baker MG, Barnard LT, Kvalsvig A, Verrall A, Zhang J, Keall M, et al. Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study. Lancet 2012; 379 1112–9.
| Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study.Crossref | GoogleScholarGoogle Scholar | 22353263PubMed |
[3] Campbell JD, Sow SO, Levine MM, Kotloff KL. The causes of hospital admission and death among children in Bamako, Mali. J Trop Pediatr 2004; 50 158–63.
| The causes of hospital admission and death among children in Bamako, Mali.Crossref | GoogleScholarGoogle Scholar | 15233192PubMed |
[4] Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JSF, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381 1380–90.
| Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis.Crossref | GoogleScholarGoogle Scholar | 23369797PubMed |
[5] Mitchell BG, Shaban RZ, MacBeth D, Wood CJ, Russo PL. The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature. Infect Dis Health 2017; 22 117–28.
| The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 31862087PubMed |
[6] McMullan BJ, Hall L, James R, Mostaghim M, Jones CA, Konecny P, et al. Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study. J Antimicrob Chemother 2020; 75 738–46.
| 31697335PubMed |
[7] Mumford V, Baysari MT, Kalinin D, Raban MZ, McCullagh C, Karnon J, et al. Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network. J Paediatr Child Health 2018; 54 987–96.
| Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network.Crossref | GoogleScholarGoogle Scholar |
[8] Heslop L. Activity-based funding for safety and quality: a policy discussion of issues and directions for nursing-focused health services outcomes research. Int J Nurs Pract 2019; 25 e12775
| Activity-based funding for safety and quality: a policy discussion of issues and directions for nursing-focused health services outcomes research.Crossref | GoogleScholarGoogle Scholar | 31414554PubMed |
[9] Australian Bureau of Statistics. National, state and territory population. Latest release September 2021. Canberra: Australian Bureau of Statistics; 2022. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/sep-2021
[10] NSW Health. NSW ABM Portal Build 18 5 User Guide Ver 1 1. Sydney: NSW Health; 2019.
[11] Australian Commission on Safety and Quality in Health Care. Hospital Acquired Complications. 2019. Available at https://www.safetyandquality.gov.au/our-work/indicators/hospital-acquired-complications
[12] Damato A. Improving patient outcomes: leveraging data to drive innovation in health care – New South Wales’ Activity-Based Funding management portal. BMC Health Serv Res 2015; 15 A1
[13] Health Policy Analysis. Analysis of hospital-acquired diagnoses and their effect on case complexity and resource use –Final report. Sydney: Australian Commission on Safety and Quality in Health Care; 2013.
[14] Australian Bureau of Statistics. Consumer Price Index, Australia, March 2021. Canberra: Australian Bureau of Statistics; 2021. Available at https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/consumer-price-index-australia/latest-release [Accessed 21 July 2021]
[15] McMullan BJ, Mahony M, Java L, Mostaghim M, Plaister M, Wu C, et al. Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach. BMJ Open Qual 2021; 10 e001120
| Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach.Crossref | GoogleScholarGoogle Scholar | 33731484PubMed |
[16] Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians, June 2016. Catalogue number 3238.0.55.001. Table 1 Estimated resident Aboriginal and Torres Strait Islander population, States and territories – 5 year age groups (to 85 and over) – 30 June 2016; Table 3 Estimated resident population, States and territories – 5 year age groups (to 85 and over) – 30 June 2016. 2018. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/
[17] Commonwealth of Australia. Closing the Gap. 2020. Available at https://www.closingthegap.gov.au
[18] Australian Institute of Health and Welfare. Hospital activity low during early months of COVID-19 pandemic. 2021. Available at https://www.aihw.gov.au/news-media/media-releases/2021-1/june/hospital-activity-low-during-early-months-of-covid
[19] Valentine JC, Worth LJ, Verspoor KM, Hall L, Yeoh DK, Thursky KA, et al. Classification performance of administrative coding data for detection of invasive fungal infection in paediatric cancer patients. PLoS One 2020; 15 e0238889
| Classification performance of administrative coding data for detection of invasive fungal infection in paediatric cancer patients.Crossref | GoogleScholarGoogle Scholar | 32903280PubMed |
[20] Valentine JC, Haeusler G, Worth L, Thursky K. Sepsis incidence and mortality are underestimated in Australian intensive care unit administrative data. Med J Aust 2019; 210 188–.e1.
| Sepsis incidence and mortality are underestimated in Australian intensive care unit administrative data.Crossref | GoogleScholarGoogle Scholar | 30761537PubMed |
[21] van Mourik MSM, van Duijn PJ, Moons KGM, Bonten MJM, Lee GM. Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review. BMJ Open 2015; 5 e008424
| Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review.Crossref | GoogleScholarGoogle Scholar |