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Association between evening admissions and higher mortality rates in the pediatric intensive care unit
Yeseli Arias1, Douglas S Taylor, James P Marcin
1Department of Pediatrics, University of California, Davis, Sacramento, California 95817, USA.
Insights
Pediatric patients admitted to the pediatric intensive care unit (PICU) during evening hours face a higher risk of death. Weekend admissions did not show a significant difference in mortality rates.
Area of Science:
- Pediatric intensive care
- Critical care medicine
- Health services research
Background:
- Inconsistent findings exist regarding the impact of admission timing on mortality rates.
- Research has not specifically addressed this in the pediatric intensive care unit (PICU) population.
Purpose of the Study:
- To investigate the association between admission time (weekday vs. weekend, daytime vs. evening) and mortality risk in pediatric ICU patients.
- To analyze data from a national sample of PICUs to determine if admission timing influences patient outcomes.
Main Methods:
- Retrospective analysis of 20,547 emergency PICU admissions from May 1995 to December 2001.
- Used mixed-effects, multivariate logistic regression to analyze the odds of death.
- Adjusted for illness severity using the Pediatric Risk of Mortality III score.
Main Results:
- Evening admissions were associated with higher odds of death (OR: 1.28; 95% CI: 1.00-1.62).
- Increased mortality risk observed in subgroups with shock, congenital cardiovascular disease, or after cardiac arrest.
- No significant association found between weekend admissions and mortality rates.
Conclusions:
- Evening admission to the PICU is linked to an increased risk of death for certain pediatric patients.
- Further research is needed to explore if care structure or processes contribute to this disparity.
Background:
Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population.
Objective:
To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs.
Design/Methods:
We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score.
Patients:
All 20,547 emergency PICU admissions made between May 1995 and December 2001 were included in the analyses.
Main Outcome Measures:
The primary outcome was death within 48 hours after admission to the PICU.
Results:
Pediatric patients admitted to the PICU during evening hours had higher odds of death (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.00-1.62) than did those admitted during daytime hours. Subgroup analyses revealed higher odds of death among patients admitted with shock (OR: 4.09; 95% CI: 1.65-10.1), with congenital cardiovascular disease (OR: 3.90; 95% CI: 1.37-11.1), or after cardiac arrest (OR: 1.80; 95% CI: 1.04-3.13). There was no association between mortality rates and the day of admission (weekend admissions versus weekday admissions).
Conclusions:
An increased risk of death exists for some pediatric patients admitted to the PICU during evening hours. It remains necessary to determine whether this finding results from differences in the structure of care, processes of care, or both.