TY - JOUR
T1 - Frequency, risk factors, and outcomes of early unplanned readmissions to picus*
AU - Edwards, Jeffrey D.
AU - Lucas, Adam R.
AU - Stone, Patricia W.
AU - Boscardin, W. John
AU - Dudley, R. Adams
PY - 2013/12
Y1 - 2013/12
N2 - 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.
AB - 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.
KW - Child
KW - Hospital readmission
KW - Intensive care units
KW - Pediatric
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U2 - 10.1097/CCM.0b013e31829eb970
DO - 10.1097/CCM.0b013e31829eb970
M3 - Article
AN - SCOPUS:84889249403
SN - 0090-3493
VL - 41
SP - 2773
EP - 2783
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -