Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2409-2417 (doi:10.1542/peds.2006-1475)
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ARTICLE

Epidemiology, Complications, and Cost of Hospitalization in Children With Laboratory-Confirmed Influenza Infection

Krow Ampofo, MB, BSa,b, Per H. Gesteland, MD, MSb,c,d, Jeffery Bender, MDb, Michelle Mills, MDe, Judy Daly, PhDf, Matthew Samore, MDg, Carrie Byington, MDa,b, Andrew T. Pavia, MDa,b and Rajendu Srivastava, MD, FRCPC, MPHb,c,d

a Divisions of Pediatric Infectious Diseases
c Inpatient Medicine
b Department of Pediatrics
g Division of Clinical Epidemiology, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
e Department of Pediatrics, University of Colorado Health Science Center, Denver, Colorado
d Institute for Health Care Delivery Research
f Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, Utah

BACKGROUND. Influenza causes significant morbidity among children. Previous studies used indirect case ascertainment methods with little cost data. We sought to measure the burden of laboratory-confirmed influenza from hospitalized children.

METHODS. We conducted a retrospective cohort study during 3 viral seasons at Primary Children's Medical Center (Salt Lake City, UT). Children ≤18 years of age who were hospitalized with laboratory-confirmed influenza infection were included. Outcomes included hospitalization rates, complications including intensive care unit stays, mechanical ventilation, length of stay, and total hospital costs.

RESULTS. A total of 325 children had hospitalizations attributable to influenza over 3 viral seasons: 28% <6 months of age, 33% between 6 and 23 months of age; and 39% >2 years of age; 37% had high-risk medical conditions. Population-based rates of hospitalization for Salt Lake County residents ranged from 6.3 to 252.7 per 100000 children. The highest rates were in children younger than 6 months, and rates decreased with increasing age. Forty-nine (15%) children had an ICU stay; 27 required mechanical ventilation, and half of these patients were >2 years of age. Total hospital cost for the cohort was $2 million; 55% was accounted for by children >2 years of age. Length of stay and total hospital costs were significantly higher in all children >2 years of age compared with children <6 months of age and were comparable to all children 6 to 23 months of age.

CONCLUSIONS. Proven influenza infection in children results in substantial hospital resource utilization and morbidity. Nationwide, the median hospital costs may total $55 million. Our data support the Advisory Committee on Immunization's recommendations to expand the use of influenza vaccine to children >2 years of age.

Key Words: influenza • children • resource utilization • complications • hospitalization

Abbreviations: ACIP—Advisory Committee on Immunization Practices • PCMC—Primary Children's Medical Center • IHC—Intermountain Health Care • EDW—Enterprise Data Warehouse • LOS—length of stay • DFA—direct fluorescent antibody • RSV—respiratory syncytial virus • ICD-9—International Classification of Diseases, Ninth Revision • IQR—interquartile range

Accepted Aug 9, 2006.




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Prevention of Influenza: Recommendations for Influenza Immunization of Children, 2007-2008
Pediatrics, April 1, 2008; 121(4): e1016 - e1031.
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