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

BACKGROUND: 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. OBJECTIVES: Our study aimed to describe the hospital-level variation in treatment of primary rhabdomyolysis and to determine how resource utilization relates to clinical outcomes. METHODS: 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. RESULTS: 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). CONCLUSIONS: There was wide variation across hospitals in all aspects of treatment for children hospitalized with rhabdomyolysis.