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Original Investigation |

Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children’s Hospitals

Elizabeth K. Goodman, BA1; Anne F. Reilly, MD, MPH1,5; Brian T. Fisher, DO, MSCE2,3,5,6; Julie Fitzgerald, MD, PhD3,4; Yimei Li, PhD1,6; Alix E. Seif, MD, MPH1,5; Yuan-Shung Huang, MS3; Rochelle Bagatell, MD1,5; Richard Aplenc, MD, PhD1,3,5,6
[+] Author Affiliations
1Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
2Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
3Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
4Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
5Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
6The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Pediatr. 2014;168(10):925-931. doi:10.1001/jamapediatrics.2014.1023.
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Importance  In adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes.

Objective  To estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia.

Design, Setting, and Participants  This retrospective cohort study from 1999 to 2011 featured index hospital admissions identified from the Pediatric Health Information System database. Participants were children with newly diagnosed acute lymphoid leukemia or acute myeloid leukemia.

Exposures  Weekend (Saturday and Sunday) or weekday index admission.

Main Outcomes and Measures  Inpatient mortality, length of inpatient stay, time to chemotherapy, and organ-system failure in index admission.

Results  A total of 10 720 patients with acute lymphoid leukemia and 1323 patients with acute myeloid leukemia were identified; 2009 patients (16.7%) were admitted on the weekend. While the total daily number of patients receiving intensive care unit–level care was constant regardless of the day of admission, these patients represented a larger percentage of total admissions on weekends. In adjusted analyses, patients admitted on the weekend did not have an increased rate of mortality during the first admission (odds ratio, 1.0; 95% CI, 0.8-1.6). Patients whose initial admission for leukemia occurred during a weekend had a significantly increased length of stay (1.4-day increase; 95% CI, 0.7-2.1), time to initiation of chemotherapy (0.36-day increase; 95% CI, 0.3-0.5), and risk for respiratory failure (odds ratio, 1.5; 95% CI, 1.2-1.7) after adjusting for demographics, severity of illness, and hospital-level factors.

Conclusions and Relevance  While pediatric patients with newly diagnosed leukemia admitted on weekends do not have higher mortality rates, they have a prolonged length of stay, increased time to chemotherapy, and higher risk for respiratory failure. Patients who are severely ill at presentation represent a higher proportion of weekend index admissions. Optimizing weekend resources by increasing staffing and access to diagnostic and therapeutic resources may help to reduce hospital length of stay across all weekend admissions and may also ensure the availability of comprehensive care for those weekend admissions with higher acuity.

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Figure.
Distribution of Total Admissions and Admissions With Positive Severe Illness Status by Day of the Week

A, The percentage of admissions by day of the week in acute lymphoid leukemia and acute myeloid leukemia populations is depicted, with Saturday and Sunday admissions having a smaller percentage than weekday admissions. B, The percentage of admissions that were severely ill at presentation, defined by use of intensive care unit–level resources within 2 days of admission, is depicted by day of the week for acute lymphoid leukemia and acute myeloid leukemia. The numbers above the bars indicate the absolute number of admissions. Weekend admissions were significantly more likely to have severe illness (P < .001).

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