Do outcomes vary according to the source of admission to the pediatric intensive care unit?*

Odetola, Folafoluwa O.; Rosenberg, Andrew; Davis, Matthew M.; Clark, Sarah J.; Dechert, Ronald E.; Shanley, Thomas P.

doi:10.1097/01.pcc.0000298642.11872.29

Cited by 97 publications

(114 citation statements)

References 31 publications

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“…In another single-center study in the United States, Odetola et al 10 found a higher risk of mortality in patients transferred from acute care units than in patients transferred from the emergency department. In a tertiary care PICU in Brazil, mortality was twice as high in patients admitted from acute care units compared with patients admitted from the emergency department.…”

Section: Discussionmentioning

confidence: 99%

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Humphreys

Totapally

2016

American Journal of Critical Care

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Background Variability in disposition of children according to the time of rapid response calls is unknown. Objective To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. Methods Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit. Results Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P < .001) than among other intensive care patients (1.4%). Conclusion Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.

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Section: Discussionmentioning

confidence: 99%

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Humphreys

Totapally

2016

American Journal of Critical Care

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“…7 Converted to cyanide by erythrocyte and tissue sulfhydryl group interactions; cyanide is converted in the liver by the enzyme rhodanase to thiocyanate (thiocyanate levels should be monitored). 8 Metabolized in the liver; Causes thrombocytopenia (may be dose-related); Milrinone is now preferred agent 9 Metabolized in the kidney; Relatively long half-life (use with caution in children with hemodynamic instability) 10 Dose may be decreased once the ductusarteriosus has opened with very little change in therapeutic effects; may cause hypotension, apnea, cutaneous flushing should be secured as rapidly as possible, followed by volume resuscitation with isotonic saline or colloid fluid boluses of 20 mL/kg every 5 minutes to a total of 60 mL/kg [29,30]. Antibiotics should be administered to children with suspected sepsis within the first 15 minutes of shock management.…”

Section: Initial Resuscitation Phasementioning

confidence: 99%

“…However, early management is critically dependent upon the early recognition and diagnosis of shock at the bedside. Failure to recognize the signs and symptoms of shock and to institute timely and appropriate care leads to higher mortality rates in both children and adults [7][8][9][10][11]. Clinical recognition of shock requires a high index of suspicion -as such, all pediatric health care providers should be cognizant of the clinical presentation, pathophysiology, and early management of shock.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Shock: An Overview

Wheeler¹,

Basu

2013

TOPEDJ

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Shock is one of the most frequently diagnosed, yet poorly understood disorders in the pediatric intensive care unit (PICU). The very definition of what constellation of physical signs and symptoms that comprise shock remains controversial, in part due to the vast array of disorders that cause shock in critically ill and injured children. Early management and reversal of the shock state is associated with significantly improved outcomes. However, early management is critically dependent upon the early recognition and diagnosis of shock at the bedside. Failure to recognize the signs and symptoms of shock and to institute timely and appropriate care leads to higher mortality rates in both children and adults. Clinical recognition of shock requires a high index of suspicion -as such, all pediatric health care providers should be cognizant of the clinical presentation, pathophysiology, and early management of shock.

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“…Studies of interhospital ICU to ICU transfers have focused mainly on the methods of transport, the obligatory preparations, frequency of transport-related adverse events, [13][14][15][16][17] and outcome and resource comparisons among transfer sources (ICU, emergency department, and general care unit). [3][4][5][18][19][20][21] ally performed at MSKCC, any associated complication, and the timing of the intervention in relation to the transfer were determined. If a planned intervention was not performed, medical records were consulted to determine the reason for deferral.…”

Section: Data Source and Study Settingmentioning

confidence: 99%

An Analysis of Patients Transferred to a Tertiary Oncological Intensive Care Unit for Defined Procedures

Kamat

Chawla

Rajendram

et al. 2015

American Journal of Critical Care

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Background Up to 50 000 intensive care unit interhospital transfers occur annually in the United States. Objective To determine the prevalence, characteristics, and outcomes of cancer patients transferred from an intensive care unit in one hospital to another intensive care unit at an oncological center and to evaluate whether interventions planned before transfer were performed. Methods Data on transfers for planned interventions from January 2008 through December 2012 were identified retrospectively. Demographic and clinical variables, receipt of planned interventions, and outcome data were analyzed. Results Of 4625 admissions to an intensive care unit at the oncological center, 143 (3%) were transfers from intensive care units of other hospitals. Of these, 47 (33%) were transfers for planned interventions. Patients’ mean age was 57 years, and 68% were men. At the time of intensive care unit transfer, 20 (43%) were receiving mechanical ventilation. Interventions included management of airway (n = 19) or gastrointestinal (n = 2) obstruction, treatment of tumor bleeding (n = 12), chemotherapy (n = 10), and other (n = 4). A total of 37 patients (79%) received the planned interventions within 48 hours of intensive care unit arrival; 10 (21%) did not because their signs and symptoms abated. Median intensive care unit and hospital lengths of stay at the oncological center were 4 and 13 days, respectively. Intensive care unit and hospital mortality rates were 11% and 19%, respectively. Deaths occurred only in patients who received interventions. Conclusions Interhospital transfers of cancer patients to an intensive care unit at an oncological center are infrequent but are most commonly done for direct interventional care. Most patients received planned interventions soon after transfer.

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Do outcomes vary according to the source of admission to the pediatric intensive care unit?*

Abstract: Outcomes of tertiary pediatric intensive care vary significantly by source of admission. Strategies aimed at reduction of mortality at the tertiary PICU should target transfer admissions from the hospital's wards and from PICUs of other hospitals.

Cited by 97 publications

References 31 publications

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Pediatric Shock: An Overview

An Analysis of Patients Transferred to a Tertiary Oncological Intensive Care Unit for Defined Procedures

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