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Do outcomes vary according to the source of admission to the pediatric intensive care unit?
Pediatr Crit Care Med. 2008 Jan; 9(1):20-5.PC

Abstract

OBJECTIVE

To examine associations between mortality, length of stay, and the sources of admission to tertiary pediatric intensive care.

DESIGN

A retrospective analysis of prospectively collected data.

SETTING

A tertiary medical center with a 16-bed medical-surgical intensive care unit and a 15-bed cardiac pediatric intensive care unit (PICU).

PATIENTS

All admissions from July 1, 1998, through June 30, 2004. Multivariable regression methods compared length of stay and mortality between the sources of PICU admission, controlling for multiple variables, including severity of illness.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of 8,897 eligible admissions, 74% were directly from the study hospital's emergency department or operating rooms, while 26% were from indirect sources, including the study hospital's wards (11%) or interhospital transfer from either non-PICU (12%) or PICU settings (3%). Compared with emergency department admissions, ward admissions had higher odds of mortality (odds ratio 1.65, 95% confidence interval 1.08-2.51), transfer admissions from non-PICU settings did not have elevated odds of mortality (odds ratio 0.80, 95% confidence interval 0.51-1.25), and inter-PICU transfer admissions had higher odds of mortality (odds ratio 1.43, 95% confidence interval 0.80-2.56), although not reaching statistical significance. Compared with emergency department admissions, ward admissions stayed almost 4 days longer in the PICU, while interhospital transfer admissions from non-PICU and PICU settings stayed 2 and 6 days longer, respectively.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA. fodetola@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18477909

Citation

Odetola, Folafoluwa O., et al. "Do Outcomes Vary According to the Source of Admission to the Pediatric Intensive Care Unit?" Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 9, no. 1, 2008, pp. 20-5.
Odetola FO, Rosenberg AL, Davis MM, et al. Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatr Crit Care Med. 2008;9(1):20-5.
Odetola, F. O., Rosenberg, A. L., Davis, M. M., Clark, S. J., Dechert, R. E., & Shanley, T. P. (2008). Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 9(1), 20-5. https://doi.org/10.1097/01.PCC.0000298642.11872.29
Odetola FO, et al. Do Outcomes Vary According to the Source of Admission to the Pediatric Intensive Care Unit. Pediatr Crit Care Med. 2008;9(1):20-5. PubMed PMID: 18477909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do outcomes vary according to the source of admission to the pediatric intensive care unit? AU - Odetola,Folafoluwa O, AU - Rosenberg,Andrew L, AU - Davis,Matthew M, AU - Clark,Sarah J, AU - Dechert,Ronald E, AU - Shanley,Thomas P, PY - 2008/5/15/pubmed PY - 2008/6/27/medline PY - 2008/5/15/entrez SP - 20 EP - 5 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 9 IS - 1 N2 - OBJECTIVE: To examine associations between mortality, length of stay, and the sources of admission to tertiary pediatric intensive care. DESIGN: A retrospective analysis of prospectively collected data. SETTING: A tertiary medical center with a 16-bed medical-surgical intensive care unit and a 15-bed cardiac pediatric intensive care unit (PICU). PATIENTS: All admissions from July 1, 1998, through June 30, 2004. Multivariable regression methods compared length of stay and mortality between the sources of PICU admission, controlling for multiple variables, including severity of illness. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 8,897 eligible admissions, 74% were directly from the study hospital's emergency department or operating rooms, while 26% were from indirect sources, including the study hospital's wards (11%) or interhospital transfer from either non-PICU (12%) or PICU settings (3%). Compared with emergency department admissions, ward admissions had higher odds of mortality (odds ratio 1.65, 95% confidence interval 1.08-2.51), transfer admissions from non-PICU settings did not have elevated odds of mortality (odds ratio 0.80, 95% confidence interval 0.51-1.25), and inter-PICU transfer admissions had higher odds of mortality (odds ratio 1.43, 95% confidence interval 0.80-2.56), although not reaching statistical significance. Compared with emergency department admissions, ward admissions stayed almost 4 days longer in the PICU, while interhospital transfer admissions from non-PICU and PICU settings stayed 2 and 6 days longer, respectively. CONCLUSIONS: 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. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/18477909/Do_outcomes_vary_according_to_the_source_of_admission_to_the_pediatric_intensive_care_unit L2 - https://doi.org/10.1097/01.PCC.0000298642.11872.29 DB - PRIME DP - Unbound Medicine ER -