Pediatric Critical Care
نویسندگان
چکیده
Critical Care Medicine www.ccmjournal.org 2773 Objectives: To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. Design: Retrospective cohort analysis. Setting: Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems. Patients: One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011. Interventions: None. Measurements and Main Results: Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed. There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0–3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002). Conclusions: Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates. (Crit Care Med 2013; 41:2773–2783)
منابع مشابه
Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety.
INTRODUCTION The measurement of quality and patient safety continues to gain increasing importance, as these measures are used for both healthcare improvement and accountability. Pediatric care, particularly that provided in pediatric intensive care units, is sufficiently different from adult care that specific metrics are required. BODY: Pediatric critical care requires specific measures for b...
متن کاملThe Collaborative Pediatric Critical Care Research Network Critical Pertussis Study: collaborative research in pediatric critical care medicine.
OBJECTIVE To provide an updated overview of critical pertussis to the pediatric critical care community and describe a study of critical pertussis recently undertaken. SETTING The six sites, seven hospitals of the Collaborative Pediatric Critical Care Research Network, and 17 outside sites at academic medical centers with pediatric intensive care units. RESULTS Despite high coverage for chi...
متن کاملCritical care for pediatric asthma: wide care variability and challenges for study.
OBJECTIVES To describe pediatric severe asthma care, complications, and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network. DESIGN Retrospective cohort study. SETTING : Pediatric intensive care units in the United States that submit administrative data to the Pediatric Health Information System. PATIENTS Children 1-18 yrs old trea...
متن کاملPediatric critical care medicine: planning for our research future.
OBJECTIVE To introduce to the pediatric critical care medicine community a new program in pediatric critical care medicine at the National Institutes of Health. DATA SOURCE Summary of literature review and conference proceedings. DATA SYNTHESIS At the National Institute of Child Health and Human Development (NICHD), a new program in pediatric critical care and rehabilitation research has be...
متن کاملPediatric Mass Casualty Incident: A Real Crisis Mandating Inter-Disciplinary Coordination, Considering Ethical Issues
Interdisciplinary coordination of the director of crisis committee with emergency and other department's staff, financial support team, public relations, rehabilitation team,and police are required to successfully manage mass casualty incidents (MCIs). Prevention, staff training, equipment availability, clear-cut responsibilities and predicting all requirements are crucial aspects to be prepare...
متن کامل