Time of Pediatric Intensive Care Unit Admission and Mortality: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to determine the association between the time of admission (day, night, and/or weekends) and mortality among critically ill children admitted to a pediatric intensive care unit (PICU). Electronic databases that were searched include PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Ovid, and Cochrane Library since inception till June 15, 2018. The article included observational studies reporting inhospital mortality and the time of admission to PICU limited to patients aged younger than 18 years. Meta-analysis was performed by a frequentist approach with both fixed and random effect models. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the quality of evidence. Ten studies met our inclusion criteria. Five studies comparing weekday with weekend admissions showed better odds of survival on weekdays (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.60–0.99). Pooled data of four studies showed that odds of mortality were similar between day and night admissions (OR: 0.93; 95% CI: 0.77–1.13). Similarly, three studies comparing admission during off-hours versus regular hours did not show better odds of survival during regular hours (OR: 0.77; 95% CI: 0.57–1.05). Heterogeneity was significant due to variable sample sizes and time period. Inconsistency in adjusting for confounders across the included studies precluded us from analyzing the adjusted risk of mortality. Weekday admissions to PICU were associated with lesser odds of mortality. No significant differences in the odds of mortality were found between admissions during day versus night or between admission during regular hours and that during off-hours. However, the evidence is of low quality and requires larger prospective studies.

Serial urinary neutrophil gelatinase associated lipocalin in pediatric diabetic ketoacidosis with acute kidney injury

“…Diabetic ketoacidosis (DKA) accounts for almost a quarter of all diabetes-related admissions to a hospital [1,2]. Several factors, including duration of illness, delayed healthcare seeking, severity of DKA, associated comorbidities, choice of fluid type and volume, and the extent of organ dysfunction determine outcome [3][4][5]. Among organ dysfunctions, acute kidney injury (AKI) has been reported in about 30-65% of children with DKA, at the time of presentation [6][7][8][9].…”

Association between off-hour admission of critically ill children to intensive care units and mortality in a Japanese registry

“…Since the effect of "off-hour" admission might be influenced by the existing healthcare system, a large variation in outcomes might be observed across different regions. Therefore, there is a need to conduct such a study in each region 3 . Previously, Japanese researchers investigated the association between "off-hour" admission and patient outcomes for several critical diseases among adults and concluded no significant correlation [4][5][6][7][8] .…”

Amitraz poisoning – an uncommon pesticide poisoning in children

“…Cardiovascular manifestation was seen in about one-third of cases, while hyperglycemia was seen in almost half of them. Death occurred in 1.9% of patients, the causes being respiratory failure, pulmonary embolism, sepsis and arrhythmia [11].…”