Hospitalization Trend for Children and Adolescents with Sickle Cell Disease in the USA: A Pediatric Health Information Database Analysis
Authors: Kalpatthi Ram , Lee Brian R. , Dalal Jignesh 
Published: October 2019

Abstract
Abstract 479

Introduction:
Over the past several decades, survival of young children with sickle cell disease (SCD) has improved dramatically with innovations in basic science and clinical care Historically, interventions such as newborn screening, prophylactic penicillin, and immunization against invasive bacteria played a significant role in decreasing childhood mortality Other advances in preventive care such as hydroxyurea therapy and comprehensive care have been increasingly postulated as the next line of innovations to improve outcomes for children with SCD, particularly with respect to VOC. There is scanty literature about the pattern of hospitalization for children with SCD in US. As hospitalization consumes lots of economic resources, we studied the trend of hospitalization of children with sickle cell disease over the last decade.

Methods:
We used the Pediatric Health Information System (PHIS), a database of clinical and financial data from free-standing children's hospitals in the US. Only patients under the age of 21 who were hospitalized at one of the 35 PHIS hospitals that provided discharge data from 2000–2011 were included in the analysis. We examined patient demographics, timing of hospitalizations, complications, and prescription medication for these patients. The PHIS database provides an encrypted patient medical record number, thus we were able to follow patients over time. This allowed for a better visualization of the patient's hospitalizations, complications, and medications over 11 years.

Results:
From 2000 to 2011, there were 1635 unique pediatric patients with SCD accounting for 9222 hospitalizations in 35 children's hospitals in the USA. Overall, the number of new patients with SCD getting hospitalized has decreased consistently every year during the study period (Figure 1A). Specifically, there was a dramatic decrease in the number of new patients getting hospitalized in the southern USA compared to other regions. There was a sharp decline in the overall number of hospitalizations from the year 2003 to 2004 (1200 vs. 500 hospitalizations respectively). However, the hospitalization rate after 2004 remained similar till the year 2011. There was no difference between males and females in the hospitalizations rate. SCD patients aged 13–21 years accounted for higher number of hospitalizations where as patients aged 6–12 years accounted for the lower number of hospitalizations (Figure 1B). Patients with Hb-SS phenotype accounted for majority of the hospitalizations (Figure 1C). Vasoocclusive crises (VOC) remained the most common reason for hospitalization. There was only one hospitalization for pneumococcal sepsis (Table 1). There was only 250 patients (15%) were found to have receiving hydroxyurea.

Conclusions:
Our data show a decreasing trend of hospitalizations for new SCD patients in the USA suggesting an overall improvement of comprehensive health care for these patients. This is consistent with the report by Day et al from the United Kingdom. Despite MSH and Baby HUG study trials demonstrating the efficacy of hydroxyurea, it was significantly underutilized, as VOC remains the major indication of hospitalization. Studies addressing the barriers of hydroxyurea use, clinical trials of Vitamin D or glutamine supplementation are needed to prevent or decrease this major health burden (VOC) in this population.

Disclosures:
No relevant conflicts of interest to declare.