O0571 Oct.4: 10:29am - Trends in Hospitalizations of Acute Pediatric Osteomyelitis: Are we Reaching a Paradigm Shift?

Background: Acute hematogenous osteomyelitis is a frequent cause of hospitalization and current literature suggests that early transition to oral antibiotics may be equally as effective as long-term intravenous antimicrobial administration. Our aim was to explore contemporary trends in acute osteomyelitis hospitalizations, resource utilization, and central/peripherally inserted central catheter (PICC) line placement among hospitalized children with osteomyelitis in the United States.

Methods: This was a retrospective, serial cross-sectional study using data from the 2007-2016 editions of the National Inpatient Sample, the largest healthcare database in the United States. Pediatric hospitalizations assigned a diagnosis of acute hematogenous osteomyelitis were identified using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD-9/10-CM) codes. Neonates, patients with sickle cell disease, cancer-related diagnosis and concurrent chronic osteomyelitis were excluded. The primary outcomes were rate of osteomyelitis, resource use, and PICC line placement. The rate of osteomyelitis was expressed as the number of pediatric hospitalizations with osteomyelitis per 100,000 hospitalizations. Trends in the rate of osteomyelitis hospitalizations with respect to age groups, gender, race, hospital region and site of infection were examined. Resource use was determined by length of stay (LOS) and hospital cost and central/PICC line placement. For trend analysis, the chi-square test for proportions using the Cochran-Armitage test and survey linear regression was used. Survey logistic regression was used for LOS and Cost.

Results: A total of 13,903 acute osteomyelitis hospitalizations were identified from 2007-2016 with a hospitalization rate of 79.2 per 100,000 children. During the study period, despite an increase in the rates of hospitalization from 54.1 to 120.9 (P trend <0.001), PICC line insertion in these children decreased from 59.8% to 7.4 % (P trend < 0.001) and the LOS reduced from 5.4 days to 4.8 days (P trend 0.04). The hospital cost remained stable at $11643 to $13 021 (P trend 0.07). Overall, the likelihood of LOS decreased with the increasing year (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99) whereas, PICC line placement increased the odds of LOS (OR 1.66, 95% CI 1.52-1.82) and had higher odds of having cost greater than the median (OR 1.65 95% CI 1.51-1.80).

Conclusion: Although the rate of hospitalization continues to steadily increase, the inflation-adjusted cost of hospitalization remained stable. The length of stay and the PICC line placements among these hospitalized patients has declined which reflects some change in clinical practice. Additional studies are needed to better understand these trends and to consider establishing clinical practice guidelines for early transition to oral antibiotics and cost-effective management.