Background/Purpose: To describe patient demographics, admission characteristics and clinical care for hospitalized patients with childhood-onset systemic lupus erythematous (SLE).

Methods: Retrospective cohort study of the Pediatric Health Information System (PHIS) database, January 1, 2004 to December 31, 2010. The PHIS database was developed by the Children’s Hospital Association and contains comprehensive administrative inpatient data from 43 independent, freestanding, pediatric hospitals in the United States. A total of 42 hospitals and 279.6 hospital-years of data were included in this analysis. The study cohort includes subjects with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis code for SLE (710.0) who had their first admission during the study period and were between 5-17 years old. Routine hospitalizations for intravenous (IV) cyclophosphamide were defined as hospitalizations with IV cyclophosphamide administration and a length of stay (LOS) of ≤ 2 days.  ICD-9-CM and clinical transaction codes were used to identify commonly performed procedures and medications administered.

Results: We identified 11,647 admissions by 3,085 patients for childhood-onset SLE during the seven-year study period.  Subjects had a median age (interquartile range (IQR)) of 14 (12-16) years, 81.7% were female, 36.3% African-American, 25.3% Hispanic, 21.8% White and 5.8% Asian. The median (IQR) and mean (SD) number of admissions per patient were 2 (1-4) and 3.8 (5.1) respectively. Fifty-one percent had a LOS of ≤ 2 days. Short-stay admissions associated with cyclophosphamide administration accounted for 2,108 (or 18.1%) of the total hospital admissions. Over the study period 25.5% of subjects had at least one admission to the intensive care unit. Table 1 summarizes the frequency of commonly performed procedures and administration of relevant medications. Fifty-nine (1.9%) subjects died during the study period resulting in an inpatient mortality per admission of 0.5%.

Conclusion: Utilizing the PHIS database, we identified a large cohort of hospitalized patients with childhood-onset SLE. Based on subject demographics and the expected frequency of commonly performed procedures and treatment, this cohort appears to be representative of the childhood-onset SLE population in the United States. Further work is needed to determine cause for admissions, subsequent treatment, and longitudinal outcomes for this cohort.

Table 1. Clinical care for childhood-onset SLE subjects in the PHIS database.

	By Admission	By Subject
	n= 11647	n=3085
Imaging, No. (%)
Abdominal  CT	607 (5.2)	475 (15.4)
Brain CT	714 (6.1)	529 (17.4)
Brain MRI	896 (7.7)	679 (22.0)
Brain MRA	515 (4.4)	418 (13.5)
Procedures, No. (%)
Renal Biopsy	1080 (9.3)	932 (30.2)
Dialysis±	963 (8.3)	261 (8.5)
Electroencephalogram (EEG)	514 (4.4)	401 (13.0)
Ventilation Assistance	218 (1.9)	196 (6.4)
Immunosuppressive medications, No. (%)
Any oral steroid	7206 (61.9)	2235 (72.4)
Methylprednisolone	5318 (45.7)	1992 (64.6)
Hydroxycholoroquine	5902 (50.7)	1767 (57.2)
Cyclophosphamide	3189 (27.4)	973 (31.5)
Mycophenolate Mofetil	2359 (20.3)	905 (29.3)
Azathioprine	613 (5.3)	298 (9.7)
Rituximab	580 (5.0)	288 (9.3)
Tacrolimus	285 (2.4)	127 (4.1)
Methotrexate	163 (1.4)	117 (3.8)
Immune Globulin (IVIG)	527 (4.5)	311 (10.1)
CT = Computed Tomography MRI= Magnetic Resonance Imaging MRA= Magnetic Resonance Angiogram ± Includes hemodialysis and peritoneal dialysis

 

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/hospitalizations-for-patients-with-chilhood-onset-systemic-lupus-erythematosus-in-the-pediatric-health-information-system-databse/