Variation in treatment and clinical outcome of rhabdomyolysis in children's hospitals.

Abstract

Data in the last decade demonstrate an increase in pediatric hospitalizations for primary rhabdomyolysis. In 2020, the American Academy of Pediatrics released a general review article for the treatment of rhabdomyolysis, but it lacks standardization of care. Our study aimed to describe the hospital-level variation in treatment of primary rhabdomyolysis and to determine how resource utilization relates to clinical outcomes. This was a retrospective cross-sectional study from the Pediatric Health Information System database of patients aged 0-18 years with the primary discharge diagnosis of rhabdomyolysis admitted between January 2020 and December 2023. A total of 3779 cases across 36 children's hospitals met inclusion criteria. Fluids were received by a median of 86.4% across hospitals. A variety of intravenous (IV) fluids were used, with the most common being sodium chloride by a median of (67.1%), followed by dextrose and sodium chloride (45.1%), dextrose and sodium chloride with potassium chloride (14.2%), and dextrose in water (10.4%). Acetaminophen was the most used analgesic (47.8%), followed by nonsteroidal anti-inflammatory drugs (26.9%), and opioids (11.3%). Use of imaging studies was observed in all 36 hospitals and occurred in 31.1%; (interquartile range [IQR]: 26%-35.7%). When adjusted, there was no statistical difference in length of stay (LOS) (55.7 h), or emergency department return rate (1.5%) between the high, medium, and lower utilizer groups. There was a statistically significant decrease in the 7-day readmission rate in the medium compared with the high utilizer group (odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.33-0.96). There was wide variation across hospitals in all aspects of treatment for children hospitalized with rhabdomyolysis.