Authors :
Presenting Author: Mark McManis, PhD – Baylor College of Medicine
Gustavo Charia-Ortiz, MD – Baylor College of Medicine
Sreenivas Avula, MD – Baylor College of Medicine
Jose Aceves, MD – Baylor College of Medicine
Melissa Svoboda, MD – Baylor College of Medicine
Jordan VanZant, MD – Baylor College of Medicine
Amanda Burkhalter, APRN, CPNP-AC – Baylor College of Medicine
Shannon Humphrey, APRN, CPNP-AC – Baylor College of Medicine
angela Childers, CNRN – Chrustus Children's Hospital
Freedom Perkins, MD – Baylor College of Medicine
Rationale:
Hospital readmission has become a key value-based health care quality measure, with the Centers for Medicare and Medicaid Services (CMS) penalizing hospitals for high readmission rates. While much of this attention has focused on adult populations, future initiatives will likely expand to include common pediatric and neurologic conditions. In pediatric neurology, unplanned readmissions remain poorly studied but represent a critical target for discharge planning and patient education. Evidence suggests that children from lower socioeconomic backgrounds experience higher readmission rates, often due to limited access to primary care, unrecognized comorbidities, weak transitions, and reduced outpatient support. Successful strategies have included identifying high-risk patients and integrating nurse discharge advocates, follow-up clinics, and care coordination efforts to enhance continuity of care.
This study examines the factors related to pediatric readmission to develop a model that will help identify patients at high risk for readmission.
Methods:
Cases were selected from a regional pediatric hospital in San Antonio, Texas. A review of cases from May, 2024 through February, 2025 identified 18 readmissions, involving 12 separate patients, following discharge. There were 11 females and 7 males. Fourteen patients were identified as White and 14 identified as Hispanic. The age range for all patients was 4 months to 16 years of age. The median age was 12 months, and the mean age was 49 months. Seizures were listed as the primary diagnosis in 11 cases.
Results:
Twenty-two percent (4/18 readmissions) were due to a single patient. The patient was initially admitted at two months of age and was ultimately diagnosed with SMC1A (epileptic encephalopathy) and placed on the ketogenic diet. A second patient accounted for another 17 percent of readmissions (3/18). This patient presented with febrile status epilepticus and was diagnosed with Dravet syndrome. A third patient with multiple readmissions had two readmissions due to the presence of febrile illness (UTI). Thus, 50% (9/18) identified readmissions were due to 3 of the 12 identified patients, showing the disease severity is a major contributor to hospital readmissions.
An additional finding was that 15 of the readmissions involved patients with Medicaid while only 3 involved patients with Commercial/Private Insurance. This is consistent with the literature and may reflect problems with access to care or medication.
We did not see any relationship between ethnicity and hospital readmission.
Conclusions:
The greatest contributor to readmissions in our sample was disease severity. Readmission frequency was also associated with insurance type. Both of these variables are complex and need to be further investigated to identify quantifiable factors that can then be applied to developing a model that will aid in predicting hospital readmissions and improve patient care, as well as hospital resource allocation.Funding: none