A Case-Control Study of IV Infiltrates in American Children's Hospitals
Rachel Danforth MD, William Wooden MD, William Bennett MD
Presenter: Rachel Danforth
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Extravasation injuries are a frequent source of morbidity across a wide range of clinical settings. Plastic surgeons are often consulted to manage the most severe of these injuries. Despite the frequency of extravasation events, the literature regarding epidemiology, outcomes, and cost is limited.
Methods: We performed a retrospective analysis using the Pediatric Health Information System (PHIS), an administrative database with data from 46 children's hospitals. We assessed inpatient encounters from 2004 through 2016 with ICD-9 (999.8X) and ICD-10 (T80.81X) codes consistent with IV infiltrate injury. We collected patient demographics and assessed for medications to treat infiltrates, presence of compartment syndrome, skin grafting, total cost, readmissions, and length of stay. We obtained inpatient controls at random at a ratio of 10:1.
Results: We identified 1,085 patients with IV infiltrates and 10,850 controls. Patients with infiltrates were more likely to be less than 1 year of age, have required ICU care, and have received TPN. In the IV infiltrate group, hyaluronidase was administered to 34.9%, sixteen (1.47%) developed compartment syndrome, and 15 (1.38%)required skin grafting. On multivariate analysis, IV infiltrates were independently associated with increased cost (OR=2.94; p<0.001), readmission (OR=1.85; p<0.001), and increased length of stay (OR=4.13; p<0.001).
Conclusions: Extravasation injuries are preventable, costly, and potentially devastating events. There appears to be opportunity for plastic surgeons to make significant strides in more efficacious treatment. A better understanding of the scope of the problem and current management trends will be valuable for future education and prevention.