Unscheduled Readmissions to the PICU

Czaja, Angela S.; Hosokawa, Patrick; Henderson, William G.

doi:10.1097/pcc.0b013e3182917a68

Cited by 43 publications

(34 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both MADMs [ 7 – 9 ] and CCCs [ 10 ] have been associated with increased PICU mortality. In congruence, patients with MADMs and predominantly CCCs should exhibit poorer long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were then assigned into two groups depending on the presence of a single admission (SADM) or multiple admissions (MADM) to the PICU. Patients with more than one admission were assigned to early or late readmission groups in conjunction with earlier studies [ 7 , 8 ]. Early readmission was defined as being readmitted within 48 hours of discharge from PICU, while late readmission was defined as being readmitted after 48 hours post PICU discharge.…”

Section: Methodsmentioning

confidence: 99%

“…Compared to the Swedish pediatric population without ICU admission, this cohort displayed a persisting 20-fold increase in mortality rate for at least five years post PICU admission. Prior studies have shown that repeated admissions to PICU care and complex chronic/health conditions are associated with increased PICU mortality [ 7 – 11 ]. However, the various factors predicting survival over time after admissions or readmissions to PICU have not previously been investigated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Survival after PICU admission: The impact of multiple admissions and complex chronic conditions

et al. 2018

View full text Add to dashboard Cite

ObjectiveFactors predicting survival over time after pediatric intensive care unit (PICU) admissions are not fully understood. The primary aim of the current study was to investigate whether multiple admissions (MADM) compared to single PICU admissions (SADM) were associated with poor survival over time after being admitted to PICU facilities. Our secondary aim was to investigate if the presence of a complex chronic condition (CCC) would further impair prognosis.DesignA closed cohort of all children up to 16 years of age admitted to the three PICUs in Sweden between 2008 and 2010 was prospectively collected and followed until 2012, providing survival data for at least one but up to four years of follow-up.SettingThree Swedish tertiary referral centers for pediatric intensive care and extracorporeal membrane oxygenation (ECMO) care were used.PatientsIn total, 3,688 Swedish children with 5,019 PICU admissions were included.InterventionsNo interventions were conducted.MeasurementsAn extensive data set was recorded, including up to four-year survival information following first PICU admission. The patients were assigned to seven admission diagnostic groups, which were then divided into SADM or MADM groups. The difference in survival over time and mortality rates (MR) and mortality rate ratios (MRR) were calculated. SADM and MADM groups with and without an existing CCC were formed. The difference in survival over time between groups was calculated.Main resultsA highly significant difference in survival over time was noted between SADM and MADM patients (p<0.0001), which was intensified by the presence of a CCC. MADM patients with a CCC had the worst outcome, while SADM patients without a CCC had the best outcome. MADM patients with no CCC demonstrated decreased survival over time compared to SADM patients with a CCC. Survival over time was statistically worsened for patients with MADM compared to SADM for the following admission diagnostic groups: Cardiovascular, Gastrointestinal/Renal, Respiratory, Neurological, and Miscellaneous. The mortality rate (deaths/patient year of follow-up) during the time of follow-up was 0.023 for SADM and 0.062 for MADM patients. The mortality rate ratio (MRR) between these groups was 2.69.ConclusionCompared to single admissions, multiple admissions to PICU were associated with a significant decrease in survival over time in some but not all diagnostic groups. Regarding our secondary aim, we found that when the presence of a CCC is factored into the survival analysis, survival over time is further impaired.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Survival after PICU admission: The impact of multiple admissions and complex chronic conditions

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Previous studies of PICU readmissions focused on early unplanned readmissions, included only readmissions within the same hospitalization, conflated planned and unplanned readmissions, and/or reflected a single institution (4, 11–12, 24–26). These studies showed that chronic conditions were associated with PICU readmissions.…”

Section: Discussionmentioning

confidence: 99%

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards

Lucas

Boscardin

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

Objectives To determine the incidence of unplanned readmissions to pediatric intensive care units (PICUs) within one year and examine risk factors associated with repeated readmission. Design, Settings, & Patients Retrospective cohort study of 93,379 patients discharged between 2009 and 2010 from 76 North American PICUs. Measurements Outcomes of index admissions and unplanned readmissions were compared. Timing of readmissions and variation of proportion of readmissions across sites were examined. Cumulative incidence curves for readmission were constructed. Time-to-event analyses were performed to examine factors associated with readmission within one year and to estimate their hazard ratios (HR). Main Results Eleven percent (10,233) of patients had 15,625 unplanned readmissions within one year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared to index admissions (4.0% versus 2.5%, and 2.5 versus 1.6 days, all P<0.001). Median time to readmission was 30 days for all readmissions; 3.5 days for readmissions during the same hospitalization; and 66 days for different hospitalizations. Time-to-event analyses showed that having more complex chronic conditions (CCCs) was associated with earlier readmission—adjusted HR 2.9 for one CCC; HR 4.8 for two CCC; HR 9.6 for three or more CCC, all P<0.001 compared no CCC). Most specific CCC conferred a greater risk of readmission, and some had considerably higher risk than others. Conclusions Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with CCCs and particular conditions were at much higher risk for readmission.

show abstract

“…Despite best efforts, the incidence of code blue events or urgent need for PICU readmission within 48 hours of PICU discharge remains unacceptably high, with a national average of 2-8% [3][4][5]. Since unplanned PICU readmission has been associated with increased length of PICU stay and higher mortality compared to non-readmitted patients (5,6), a tool to identify this at risk population would be of great clinical utility. Identifying patients at high risk of PICU readmission will allow the ward team to monitor these patients more closely, as well as enable PICU physicians to make more informed decisions when evaluating a patient's readiness for PICU discharge.…”

Section: Introductionmentioning

confidence: 99%