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Do outcomes vary according to the source of admission to the pediatric intensive care unit?

Folafoluwa O Odetola1, Andrew L Rosenberg, Matthew M Davis

  • 1Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA. fodetola@med.umich.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|May 15, 2008
PubMed

Insights

Outcomes in pediatric intensive care units (PICUs) differ based on admission source. Strategies to reduce mortality should focus on patients transferred from hospital wards and other PICUs.

Area of Science:

  • Pediatric Critical Care Medicine
  • Healthcare Outcomes Research
  • Hospital Administration

Background:

  • Tertiary pediatric intensive care units (PICUs) manage critically ill children.
  • Patient outcomes can be influenced by the origin of admission to the PICU.

Purpose of the Study:

  • To investigate the relationship between the source of admission to a tertiary pediatric intensive care unit and patient mortality and length of stay.
  • To identify specific admission sources associated with adverse outcomes.

Main Methods:

  • Retrospective analysis of prospectively collected data from a tertiary medical center.
  • Inclusion of all admissions to medical-surgical and cardiac PICUs over a six-year period.
  • Multivariable regression analysis to compare mortality and length of stay, controlling for illness severity.

Main Results:

  • 74% of admissions were direct (emergency department/operating room), while 26% were indirect (wards, interhospital transfers).
  • Ward admissions were associated with significantly higher mortality odds (OR 1.65) and longer PICU stays (+4 days) compared to emergency department admissions.
  • Inter-PICU transfers showed higher mortality odds (OR 1.43) and the longest PICU stays (+6 days), though not statistically significant.

Conclusions:

  • Significant variations in tertiary pediatric intensive care outcomes exist based on admission source.
  • Targeting interventions for patients admitted from hospital wards and inter-PICU transfers is crucial for reducing mortality.
Abstract

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