Investigators from Weill Cornell Medicine/New York-Presbyterian Komansky Children’s Hospital, New York, NY, and Herbert Wertheim College of Medicine, Miami, FL, conducted a retrospective study to describe the epidemiology of pericardial effusion (PCE) in hospitalized children and identify risk factors for drainage of the effusion and in-hospital mortality. For the study, they reviewed data in the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database (KID) 2016, which contains demographic information and ICD-10 diagnostic codes for children hospitalized in the United States. Using the ICD-10 codes, children <20 years old with a diagnosis of PCE were identified. The investigators used Clinical Classification Software to collapse multiple ICD-10 diagnostic and procedural codes into etiologic categories, including cardiac structural diagnosis, rheumatologic diagnosis, hematologic malignancy diagnosis, solid organ tumor, organ transplant, and other. Because of problems with adequately classifying infectious etiologies, infectious diagnosis was not a specific etiologic category. The proportion of cases of PCE related to each of the etiologic categories, and by age group (0-28 days, 1-11 months, 1-5 years, 6-12 years, and 13-20 years), was calculated. Multivariate binary regression was used to identify independent risk factors for drainage of PCE and death. Age group and etiologic categories were included in the models. ICD-10 codes were used to identify confounding variables for the regression analyses including acute respiratory failure, acute kidney injury or hemodialysis, and a calculated All Patient Refined Diagnosis Related Groups risk of mortality score. Drainage of the PCE was included in the analysis of risk factors for death.
A total of 6,417 pediatric patients with PCE were identified in the KID 2016 database, with a median age of 4 years. The most common etiology for the effusion in these children was cardiac structural diagnosis (N = 2,532), followed by cardiac surgery (1,822), other etiology (1,734), rheumatologic diagnosis (968), hematologic malignancy (683), solid organ tumor (598), and organ transplant (167); some patients had multiple etiologies. The PCE was drained in 792 (12.3%) patients, and 436 (6.8%) children died. In the multivariate model, compared to other etiologies, cardiac surgery was associated with an increased risk of PCE drainage (OR, 2.57; 95% CI, 2.11, 3.13). Neonates <29 days old were significantly less likely to have drainage of PCE than older aged patients. Conversely, the mortality rate among neonates with PCE (12.4%) was significantly higher than in older children. Patients with PCE caused by solid tumors were at greater risk of death than those with other etiologies (OR, 1.54; 95% CI, 1.06, 2.24), and children with drainage of their PCE were also a greater risk of death than those not requiring drainage (OR, 1.43; 95% CI, 1.07, 1.92).
The authors conclude that neonates and children with PCE associated with...