122
LETTERS
TO
THE
EDITOR
a e
he
ini ial
consul a ion.
This
aises
ques ions
abou
he
pe inence
o
some
o
he
e e als.
Some
s udies
sugges
ha
a
combina ion
o
pee
e i-
sion,
he
use
o
s uc u ed
p o ocols
and
eedback
om
he
specialis
could
be
e ec i e
in
educing
he
e e al
a io.4
S a egies
aimed
a
changing
e e al
beha iou
by
GPs
may
be
e ec i e
bo h
in
educing
hese,
and
imp o ing
he
cha -
ac e is ics
o
he
e e als.3
In
ou
uni
he
exis ing
e e al
sys em
does
no
allow
eques s
o
addi ional
in o ma ion
abou
he
e e ed
pa ien
and
so
he e
a e
no
e usals
based
on
lack
o
clinical
da a.
Ne e heless
i
is
impo an
o
eflec
ha
e e al
p ocedu es
which
a e
p ope ly
in o ma i e
and
di ec ed,
may
lead
o
he
imp o ed
sc eening
o
submi -
ed
eques s,
op imising
exis ing
hospi al
esou ces.
Taking
his
in o
accoun ,
models
o
p o ocols
o
his
e ec
may
be
use ul,
acili a ing
he
p ocess,
and
p o iding
an
in e ac-
ion
wi h
he
eques e
in
o de
o
imp o e
a
good
e e al
assessmen ,
minimising
he
lack
o
essen ial
in o ma ion,
and
en iching
ou
pa ien
sa e y.
The
pu pose
o
p o ocols
is
o
ob ain
all
necessa y
in o -
ma ion
based
on
‘‘obliga o y
i ems’’
o
each
pa ame e
so
ha
u gency
o
he
eques s
is
be e
s a ified,
ime
o
p ecise
diagnose
imp o ed
and
mo e
app op ia e
ea men
achie ed.
This
will
con ibu e
o
a
sa e
and
as e
pa ien
app oach.
The e o e,
his
s a egy
appea s
o
be
some hing
which
needs
o
be
de eloped
and
implemen ed,
wi h
a
subsequen
e alua ion
o
i s
e ec
and
sa e y,
in
o de
o
es ima e
he
impac
o
he
measu es
aken
o
all
he
elemen s
in ol ed.
Conflic s
o
in e es
The e
we e
no
conflic s
o
in e es .
Acknowledgemen s
This
esea ch
did
no
ecei e
any
specific
g an
om
unding
agencies
in
he
public,
comme cial,
o
no - o -p ofi
sec o s.
Re e ences
1.
Tho sen
O,
Ha ei
M,
Bae heim
A.
Gene al
p ac i ione s’
eflec-
ions
on
e e ing:
an
asymme ic
o
non-dialogical
p ocess?
Scand
J
P im
Heal h
Ca e.
2012;30:241---6.
2.
Fo es
CB,
Nu ing
PA,
on
Sch ade
S,
Rohde
C,
S a field
B.
P i-
ma y
ca e
physician
special y
e e al
decision
making:
pa ien ,
physician,
and
heal h
ca e
sys em
de e minan s.
Med
Decis
Mak-
ing.
2006;26:76---85.
3.
Winpenny
EM,
Miani
C,
Pi ch o h
E,
King
S,
Roland
M.
Imp o ing
he
e ec i eness
and
e ficiency
o
ou pa ien
se ices:
a
scoping
e iew
o
in e en ions
a
he
p ima y-seconda y
ca e
in e ace.
J
Heal h
Se
Res
Policy.
2017;22:53---64.
4.
Cox
JM,
S eel
N,
Cla k
AB,
Kuma a el
B,
Bachmann
MO.
Do
e e al-managemen
schemes
educe
hospi al
ou -
pa ien
a endances?
Time-se ies
e alua ion
o
p ima y
ca e
e e al
managemen .
B
J
Gen
P ac .
2013;63:
e386---92.
5.
Pi e man
L,
Ko i sas
S.
Pa
II.
Gene al
p ac i ione -specialis
e e al
p ocess.
In e n
Med
J.
2005;35:491---6.
B.
Ramosa,b,∗,
C.C.
Lou ei ob,c
aCen o
Hospi ala
e
Uni e si á io
de
Coimb a,
Hospi ais
da
Uni e sidade
de
Coimb a,
Po ugal
bPneumology
Uni ,
Hospi ais
da
Uni e sidade
de
Coimb a,
Cen o
Hospi ala
e
Uni e si á io
de
Coimb a,
Coimb a,
Po ugal
cCen e
o
Pneumology,
Facul y
o
Medicine,
Uni e si y
o
Coimb a,
Coimb a,
Po ugal
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(B.
Ramos).
h ps://doi.o g/10.1016/j.pulmoe.2018.12.007
2531-0437/
©
2019
Sociedade
Po uguesa
de
Pneumologia.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-
nd/4.0/).
Hospi al
admissions
in
child en
wi h
acu e
espi a o y
disease
in
Po ugal
KEYWORDS
As hma;
B onchioli is;
Child en;
Hospi aliza ion;
Pneumonia;
Po ugal;
Adminis a i e
da a
B onchioli is,
as hma
and
pneumonia
a e
leading
causes
o
hospi al
admission
o
acu e
illness
in
pedia ic
popula ion,1 anking
among
he
op
10
o
inpa ien
cos s.2 --- 4
Le el
o
hospi al
ca e,
bo h
clinical
and
nonclinical
p oce-
du es
and
leng h
o
hospi al
s ay
(LoS),
ep esen
a ge s
o
esou ce
use
op imiza ion.5
The
iden ifica ion
o
ends
h ough
adminis a i e
da a
sou ces
p o ides
ele an
in o ma ion
o
unde s and
he
epi-
demiology
ela ed
o
disease
bu den
and
in e en ions,
and
o
op imize
esou ces
use
and
s anda ds
o
ca e.2,6,7
We
aimed
a
analyzing
cen al
adminis a i e
da a
o
acu e
pedia ic
hospi aliza ion
ends
in
Po ugal
o
b on-
chioli is,
pneumonia
and
as hma,
bo h
as
p ima y
o
sec-
onda y
diagnosis,
o e
he
decade
ha
p eceded
he
publi-
ca ion
and
implemen a ion
o
na ional
guidelines
o
hese
diseases
and
he
in oduc ion
o
pneumococcal
accines.
We
collec ed
adminis a i e
da a
(Janua y
2002---Decembe
2012)
om
he
Diagnosis-Rela ed
G oup
da abase
o
he
Po uguese
Cen al
Heal h
Sys em
Adminis-
a ion
(ACSS)
as
age- es ic ed
codes
om
he
In e na ional
LETTERS
TO
THE
EDITOR
123
Classifica ion
o
Diseases,
Nin h
Re ision,
Clinical
Modifica-
ion
(ICD-9-CM)
o
hospi al
admissions
in
mainland
Po ugal
(b onchioli is
codes
466.1,
age
ange
0---23
mon hs;
as hma
codes
493
and
pneumonia
codes
480---486).
Fo
as hma
and
pneumonia,
child en
0
o
17
yea s
old
we e
eligible
and
da a
analyzed
as
0---23
mon hs
and
2---17
yea s
o
age.
Hospi al
esou ce’s
use
was
e alua ed
by
mean
LoS,
se e i y- ela ed
p ocedu es
[non-in asi e
(NIV)
o
in asi e
en ila ion
(IV)
use]
and
inhospi al
mo ali y.
Po uguese
Na ional
Ins i u e
o
S a is ics
da a
om
2001
and
2011
Cen-
sus
was
used
o
es ima e
he
yea ly
hospi aliza ion
a e
o
each
diagnosis/100,000
inhabi an s,
adjus ed
o
age
ange
(Fig.
1).
Analysis
was
pe o med
based
on
he
p ima y
discha ge
diagnosis
o
each
condi ion.
Desc ip i e
analysis
o
demog-
aphy
was
pe o med.
T ends
in
b onchioli is,
as hma
o
pneumonia,
and
yea ly
and
heal h
adminis a i e
egions
admissions
we e
assessed
by
bi a ia e
analysis
and
linea
eg ession
(using
ime
as
independen
a iable).
Due
o
pe -
sonal
da a
p o ec ion,
and
because
o
low
numbe s
pe
age
g oup,
some
da a
on
mo ali y
was
no
disclosed.
IBM®SPSS
S a is ics
24.0
o
Mic oso ®Excel
15.39
we e
used
con-
side ing
a
significance
le el
o
5%.
Du ing
he
11-yea
s udy
pe iod
117,857
admissions
occu ed
due
o
hese
h ee- espi a o y
diagnoses:
b on-
chioli is
(n
=
52,601),
as hma
(n
=
15,315)
and
pneumonia
(n
=
48,143),
ep esen ing
a
mean
(SD)
o
4732
(357.8)
pa ien
admissions/yea
o
b onchioli is,
1330
(189)
o
as hma
and
4494
(644.1)
o
pneumonia,
as
p ima y
diag-
nosis.
Mean
(SD)
annual
equency
hospi aliza ion
was
2448.2
(186.3),
73.1
(9.1)
and
243.6
(30.0)
o
100,000
child en
o
b onchioli is,
as hma
and
pneumonia,
espec i ely.
Global
hospi al
admission
a e
o
b onchioli is
showed
a
small
nonsignifican
inc ease
in
all
heal h
adminis a-
i e
egions
( =
22.47,
p
=
0.223),
excep
o
he
Cen e
( =
−0.669,
p
=
0.024),
whe eas
o
as hma
a
nonsignifican
small
dec ease
( =
−0.535,
p
=
0.09)
occu ed,
despi e
a
non-s a is ical
significan
inc ease
end
in
No h
egion
and
Alga e.
Fo
pneumonia,
a
s a is ically
significan
dec ease
in
global
pneumonia
hospi aliza ion
a e
( =
−7.76,
p
=
0.007)
was
pe cei ed,
main ained
on
age
g oups
( =
−0.881,
p
=
0.0
in
0---23
mon hs;
=
−0.515,
p
=
0.105
in
0---17
yea s),
al hough
in
Alen ejo
and
Alga e
a
non-s a is ical
significan
inc ease
end
was
obse ed.
Demog aphic
ea u es
and
pa e ns
o
egional
dis ibu-
ion
a e
summa ized
in
Table
1.
A
sligh
p edominance
o
male
sex
is
shown
and
he
fi s
2
yea s
o
age
ep esen
61.3%
o
all
admissions
(all
cases
o
b onchioli is,
15.9%
and
37.0%
o
cases
o
as hma
and
pneumonia).
LoS
end
analysis
e ealed
a
s a is ically
significan
dec ease
o
he
h ee
condi ions
(p
=
0.000
o
b onchioli-
is
and
as hma
and
p
=
0.001
o
pneumonia),
wi h
mean
(SD)
LoS
o
5.4
(0.17),
3.1
(0.18)
and
5.9
(0.45)
days
o
b onchioli is,
as hma
and
pneumonia
espec i ely.
Hospi al
eadmissions
we e
only
a ailable
o
as hma
and
pneumonia
du ing
2011
and
2012,
which
we e
8.2%
and
8.9%
and
8.2%
and
9.4%
espec i ely.
Fo
as hma,
mechanical
en ila ion
was
documen ed
in
162
pa ien s
[NIV
in
68
and
IV
in
94]
ep esen ing
0.44%
and
0.61%
o
as hma
hospi al
admissions
and
mean
(SD)
LoS
o
mechanical
en ila ed
pa ien s
was
8.0
(5.92)
and
19.4
(6.87)
days,
o
NIV
and
IV.
Fo
pneumonia,
mechanical
en-
ila ion
was
epo ed
in
3162
pa ien s,
[NIV
in
1213
and
IV
in
1949
pa ien s]
ep esen ing
2.52%
and
4.05%
o
pneumo-
nia
hospi al
admissions,
and
a
mean
(SD)
LoS
o
mechanical
en ila ed
pa ien s
o
31.1
(7.29)
and
44.6
(7.27)
days,
o
NIV
and
IV
pa ien s.
Comple e
da a
on
mo ali y
was
no
disclosed
due
o
con-
fiden ially,
bu
11
dea hs
we e
epo ed
o
b onchioli is,
dispe sed
h oughou
he
s udy
pe iod
and
be ween
egions;
no
inhospi al
mo ali y
o
acu e
as hma
was
disclosed
and
o
pneumonia
a
mo ali y
a e
o
0.48%
was
egis e ed.
In
conclusion,
a
significan
hospi al
admission
a e
decline
o
pneumonia
was
no iced,
p obably
ollowing
he
in oduc ion
o
an i-pneumococcal
accines
as
epo ed
he e
o
he
fi s
ime
om
adminis a i e
da a
in
Po ugal
in
he
pedia ic
age
g oup,
which
pa allels
in e na ionally
epo ed
da a.8As hma
admissions
sligh ly
dec eased
o e
he
pe iod
analyzed,
which
was
al eady
epo ed
by
San-
os
N
e
al.
o
an
almos
simila
pe iod,9bo h
globally
and
unde
2
yea s
o
age.
We
ecognize
ha
he e
is
clinical
o e lapping
be ween
he
h ee
en i ies
s udied
pa icula ly
in
child en
unde
2
yea s-old.3Ou
esul s
a e
compa able
Figu e
1.
B onchioli is-
(whi e),
As hma-
(g ay)
and
Pneumonia-
(black)
ela ed
pedia ic
hospi aliza ions
in
Po ugal,
2002---2012.
(a)
Mean
numbe
o
admissions
pe
100,000
inhabi an s
aged
0---24
mon hs
o
b onchioli is
and
aged
0---17
yea s
o
as hma
and
pneumonia;
(b)
mean
numbe
o
admissions
pe
100,000
inhabi an s
in
he
fi e
heal h
adminis a i e
egions
in
Po ugal.
124
LETTERS
TO
THE
EDITOR
Table
1
Demog aphic
cha ac e is ics
o
s udy
popula ion,
numbe
and
egional
dis ibu ion
o
cases,
leng h
o
s ay
(LoS),
mechanical
en ila ion
and
in-pa ien
mo ali y
in
b onchioli is,
as hma
and
pneumonia,
2002---2012.
P ima y
diagnosis:
B onchioli is
As hma
Pneumonia
ICD-9-CM
466.1
493
480---486
Hospi al
admissions,
n
P ima y
diagnosis
52,601a15,315
48,143
Age
dis ibu ion,
n
(%)
0---23
mon hs
52,058
2437
17,707
2---17
yea s
N/A
12,858a30,147a
Sex
dis ibu ion,
n
(%)
Male
31,433
(59.7) 9278
(60.6) 26,227
(54.8)
Geog aphic
heal h
egion
dis ibu ion,
n
(%)
No h
19,588
(37.6)
4392
(28.7)
17,275
(35.9)
Cen e
10,317
(19.8)
4171
(27.3)
9939
(20.6)
Lisbon
a ea
19,003
(36.5)
5798
(37.9)
17,848
(37.1)
Alen ejo
1376
(2.6)
271
(1.8)
1409
(2.9)
Alga e
1819
(3.5) 669
(4.4)
1672
(3.5)
Hospi al
admissions/age
ange/100,000
inhabi an s,
mean
(SD)
0---23
mon hs
2448.2
(186.3)
111.9
(27.3)
834.6
(109.1)
2---17
yea s
N/A
70.1
(8.5)
166.1
(24.3)
LoS
days,
mean
(SD)
No h
5.6
(0.3)
3.1
(0.2)
5.4
(0.9)
Cen e
4.7
(0.2)
2.9
(0.4)
5.7
(0.2)
Lisbon
egion
5.5
(0.3)
3.3
(0.2)
6.4
(0.6)
Alen ejo
4.9
(0.6)
3.0
(0.9)
5.5
(0.6)
Alga e
4.5
(0.67)
3.1
(0.4)
5.4
(0.9)
Mechanical
en ila ion:
pa ien s,
n
/LoS
days,
mean
(SD)
NIV
DNA
68/8.0
(5.9)
1213/31.1
(7.3)
IV
DNA
94/19.4
(6.9)
1949/44.6
(7.3)
In-pa ien
mo ali y,
n
(%)
11
(0.02)
0
234
(0.48)
DNA:
da a
no
a ailable;
LoS:
leng h
o
s ay;
n:
o al
numbe ;
N/A:
no
applicable
based
on
disease
defini ion;
NIV:
non-in asi e
en ila ion;
IV:
in asi e
en ila ion;
SD:
s anda d
de ia ion.
aFo
a
ew
cases
age/heal h
egion
is
no
disclosed
o
easons
ela ed
o
indi idual
da a
p o ec ion
equi ed
by
he
Po uguese
law.
wi h
hose
epo ed
in
ano he
audi
whe e
a ound
1/3
o
pedia ic
as hma
hospi aliza ions
occu ed
in
child en
unde
2
yea s
o
age.10
A
sligh
inc ease
in
hospi al
admission
a e
o
b onchioli-
is
was
no iced.
A
ecen ly
published
s udy
showed
simila
esul s.11 Al hough
da a
on
eadmissions
and
en ila ion
was
no
a ailable
in
ou
s udy,
Mendes-da-Sil a
e
al
showed
an
inc ease
in
mechanical
en ila ion
mos ly
because
o
NIV
use
no
explained
by
se e i y.11 Child en
unde
2-yea s
o
age
ep esen ed
he
highes
bu den
o
all
he
acu e
diseases
in
analysis,
including
as hma
and
pneumonia
[inci-
dence
inc ease
1,6
and
5- old].
Fo
all
diseases
and
age
g oups,
male
sex
p edomina es.
In
all
g oups,
a
dec ease
in
LoS
was
no iced,
bu
he
use
o
mechanical
en ila ion
inc eased.
As
such,
ou
da a
p o-
ide
a
benchma k,
which
may
con ibu e
o
op imize
heal h
esou ces.
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con ibu ions
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lis ed
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decla e.
LETTERS
TO
THE
EDITOR
125
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J.
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Fe nandesa,
P.J.
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Bandei aa
aPedia ics
Depa men ,
San a
Ma ia
Hospi al
---
CHLN,
Lisbon
Medical
Academic
Cen e
(CAML),
Lisbon,
Po ugal
bISAMB
---
Ins i u o
de
Saúde
Ambien al,
Facul y
o
Medicine
o
he
Uni e si y
o
Lisbon,
Lisbon
Medical
Academic
Cen e
(CAML),
Lisbon,
Po ugal
cDi ec o a e
o
Analysis
and
In o ma ion
---
Di ec o a e-Gene al
o
Heal h,
Lisboa,
Po ugal
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(J.
Bo ges).
h ps://doi.o g/10.1016/j.pulmoe.2018.12.004
2531-0437/
©
2019
Sociedade
Po uguesa
de
Pneumologia.
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