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Retrospective study of haemophagocytic syndrome hospitalisations in children in the USA
  1. Aditya Badheka1,
  2. Pradeep Bangalore Prakash2,
  3. Veerasathpurush Allareddy3,
  4. Veerajalandhar Allareddy4
  1. 1 Pediatric Critical Care, Stead Family Children’s Hospital, University of Iowa, Iowa City, Iowa, USA
  2. 2 Mercy Medical Center, Des Moines, Iowa, USA
  3. 3 Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
  4. 4 Division of Pediatric Critical Care, Duke Children’s Hospital, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Aditya Badheka; aditya-badheka{at}


Introduction The haemophagocytic syndrome (HS) is a rare condition that presents with uncontrolled inflammation leading to multiorgan failure and is associated with significant morbidity and mortality. Current national estimates of children hospitalised due to HS are unknown. Characterising and understanding the burden of HS-related hospitalisations at a national level is the initial step in optimising the overall care.

Methods We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2012 to 2014. The NIS is the largest all-payer inpatient care dataset in the USA that contains more than seven million hospital stays and its large sample size is ideal for developing national estimates of rare conditions. All patients aged up to 18 years who were primarily hospitalised due to HS were selected for our study. Descriptive statistics were used. A multitude of patient-level and hospital-level variables were assessed. Outcome variables included overall in-hospital mortality, hospital charges and the length of stay.

Results A total of 840 patients aged up to 18 years were hospitalised primarily due to HS in the USA. Mean age was 5.7 years. 57.4% were males. Whites comprised 45%. 6.5% died in hospital. A vast majority (78%) were admitted on an emergency/urgent basis. The most frequent payers included Medicaid (50%) and private insurance (36.9%). Almost 80% of children had at least one comorbid condition. 96.3% of patients were treated in urban teaching hospitals. Southern regions accounted for 42.6% of all hospitalisations. The median length of stay in hospital was 9.6 days and the median hospitalisation charge was US$100 426.

Conclusion Nearly 1 in 15 children who were hospitalised due to HS died. The resource utilisation associated with HS-related hospitalisations is considerable. The majority of hospitalised children with HS had comorbid conditions.

  • hemophagocytic lymphohistiocytosis
  • mortality
  • length of stay
  • resource utilization

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  • Contributors Conceived and/or designed the work that led to the submission, acquired data and/or played an important role in interpreting the results: AB, VjA, VsA and PBP. Drafted and/ or revised the manuscript: AB, VjA, VsA and PBP. Approved the final version. AB, VjA, VsA and PBP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was deemed to not meet the regulatory requirements of human subjects research by the Office of Human Subjects Research—The University of Iowa and hence IRB approval was not needed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at Limited results of this study were presented as a poster at American Academy of Pediatrics—Society of Critical Care Colloquium meeting at Chicago, Illinois, USA (September 2017).

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