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Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions.
Pediatrics. 2008 Apr; 121(4):e906-11.Ped

Abstract

OBJECTIVE

The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital.

METHODS

We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13,017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward.

RESULTS

Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in-house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days).

CONCLUSIONS

On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children.

Authors+Show Affiliations

Department of Pediatrics, University of California Davis Children's Hospital, USA. christopher.gregory@ucdmc.ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18381519

Citation

Gregory, Christopher J., et al. "Comparison of Critically Ill and Injured Children Transferred From Referring Hospitals Versus In-house Admissions." Pediatrics, vol. 121, no. 4, 2008, pp. e906-11.
Gregory CJ, Nasrollahzadeh F, Dharmar M, et al. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics. 2008;121(4):e906-11.
Gregory, C. J., Nasrollahzadeh, F., Dharmar, M., Parsapour, K., & Marcin, J. P. (2008). Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics, 121(4), e906-11. https://doi.org/10.1542/peds.2007-2089
Gregory CJ, et al. Comparison of Critically Ill and Injured Children Transferred From Referring Hospitals Versus In-house Admissions. Pediatrics. 2008;121(4):e906-11. PubMed PMID: 18381519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. AU - Gregory,Christopher J, AU - Nasrollahzadeh,Farid, AU - Dharmar,Madan, AU - Parsapour,Kourosh, AU - Marcin,James P, PY - 2008/4/3/pubmed PY - 2008/5/1/medline PY - 2008/4/3/entrez SP - e906 EP - 11 JF - Pediatrics JO - Pediatrics VL - 121 IS - 4 N2 - OBJECTIVE: The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital. METHODS: We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13,017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward. RESULTS: Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in-house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days). CONCLUSIONS: On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18381519/Comparison_of_critically_ill_and_injured_children_transferred_from_referring_hospitals_versus_in_house_admissions_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=18381519 DB - PRIME DP - Unbound Medicine ER -