The inpatient burden of pyoderma gangrenosum and associated comorbidities in children in the United States

Abstract

Pyoderma gangrenosum is an ulcerating inflammatory condition defined pathologically by an abundance of neutrophils in the absence of infection. Often, hospital admission is necessary for rapidly progressing PG for wound care and adequate pain control. However, few large-scaled controlled studies exist examining hospitalizations for PG in the pediatric populations and the associated comorbidities. We sought to determine the prevalence, length of stay (LOS), cost of care, and any risk factors for admission and associated comorbidities in children hospitalized for PG in the U.S. Data were analyzed from the 2002 to 2012 National Inpatient Sample, including a 20% representative sample of all hospitalizations in the United States. The prevalence of hospitalization between 2002 and 2012 ranged from 2 to 11 per million hospitalized children. Hospitalization for PG was associated with older age, female gender, black race/ethnicity, the third quartile for household income, having 2–5 chronic conditions, being admitted to a micropolitan or a non-metro/micropolitan hospital and to a teaching hospital. Hospitalization with vs. without a primary diagnosis of PG was associated with significantly prolonged LOS. The total inflation-adjusted cost of care for hospitalization with a primary diagnosis of PG was $2,202,576; $200,234 per year). The geometric-mean cost of hospitalization was significantly higher in children with vs. without a primary diagnosis of PG. Children hospitalized for PG were found to have higher odds of thyroid disease, inflammatory bowel disease, hematologic malignancy, and other autoimmune disorders. While children are rarely hospitalized for PG, they have prolonged hospitalization, and clinical interventions need to be developed to prevent hospitalization for PG. Further, concomitant workup for other systemic comorbidities is also warranted at the time of diagnosis and throughout disease course.