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The development of a clinical markers score to predict readmission to paediatric intensive care
Sophie Linton1, Chelsea Grant, Juliet Pellegrini
1Paediatric Intensive Care Unit, Royal Children's Hospital, Flemington Rd, Parkville 3052, Australia. sophie.linton@rch.org.au
Insights
Reducing intensive care unit (ICU) readmissions is crucial. A new clinical score, combining patient data and nurse assessments, can predict which children are at higher risk for readmission after ICU discharge.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Quality Improvement
Background:
- Readmission to the Intensive Care Unit (ICU) post-discharge is linked to worse patient outcomes and increased healthcare costs.
- Intensive Care Unit liaison nurses (ICULNs) play a vital role in reducing these readmission rates.
Purpose of the Study:
- To identify demographic and Intensive Care Unit liaison nurse (ICULN) visit-related factors associated with pediatric ICU readmission.
- To develop a clinical markers score for predicting ICU readmission risk.
Main Methods:
- A case-control study design was employed, comparing children readmitted to the ICU within 48 hours of discharge with a control group discharged on the same day.
- Multivariate logistic regression analysis was used to identify factors associated with ICU readmission.
Main Results:
- Significant factors associated with ICU readmission included high oxygen requirements, tachypnea, extreme age (less than 2 weeks or over 10 years), ICULN assessment, a high risk of readmission (ROR) score, prolonged ICU length of stay (LOS), and oncology admission.
- These factors were analyzed to develop a predictive clinical markers score.
Conclusions:
- A predictive score for ICU readmission risk requires integrating subjective ICULN assessments, respiratory status, and patient characteristics at ICU discharge.
- This score can empower ICULNs to prioritize care for high-risk pediatric patients, potentially reducing readmissions.
Objective:
Readmission to ICU following discharge is associated with increased length of stay (LOS), increased rates of mortality, morbidity and resource consumption. Reducing readmission rates is one of the key aims of the Intensive Care Unit liaison nurse (ICULN). Our objective was to identify factors associated with readmission which were identifiable both from demographics and from each LN visit, and from this develop a clinical markers score.
Methods:
In this case control study, cases were all children who required ICU readmission within 48h of discharge over two years. The comparison group included children who were discharged on the same day as those who required readmission. Using multivariate logistic regression analysis the factors associated with ICU readmission were identified. The factors were further analysed for the development of the clinical markers score.
Results:
The factors associated with readmission to ICU included high oxygen requirement, tachypnoea, age >10 years, age <2 weeks, LN assessment, high risk of readmission (ROR) score, longer LOS and admission under oncology.
Conclusion:
From our study we found that the development of a score to predict the risk of readmission to ICU required a combination of subjective LN assessment, respiratory status and patient characteristics collected on discharge from ICU. This score can now be implemented and guide the LN to prioritise visits for children at increased risk of ICU readmission.