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Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center
Stephen J Fenton1, Stephen J Campbell2, Austin M Stevens1
1Division of Pediatric Surgery, University of Utah School of Medicine.
Insights
A significant portion of pediatric intensive care unit (PICU) admissions for injured children are preventable, leading to unnecessary healthcare costs. Developing strategies to reduce these admissions is crucial for optimizing resource allocation.
Area of Science:
- Pediatric Trauma Care
- Intensive Care Medicine
- Healthcare Resource Management
Background:
- No established criteria guide pediatric intensive care unit (PICU) admissions for injured children.
- Analysis of trauma patient admissions at a level 1 pediatric trauma center was conducted.
Purpose of the Study:
- To analyze trauma patient admissions to the PICU.
- To identify and quantify preventable PICU admissions.
Main Methods:
- Retrospective analysis of a trauma registry from 2002 to 2015.
- Defined preventable PICU admission as discharge/transfer within 30 hours without surgery, transfusion, or ventilation.
Main Results:
- 19% of 16,209 children were admitted to the PICU.
- 36% of PICU admissions were deemed preventable by the study's definition.
- Preventable admissions, particularly those with head injuries, incurred significant costs and utilized resources inefficiently.
Conclusions:
- A substantial number of pediatric intensive care unit admissions are preventable.
- These preventable admissions represent an economic burden and overutilization of healthcare resources.
- Strategies to minimize unnecessary PICU admissions should be prioritized.
Background:
No formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center.
Methods:
The trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30h without surgical intervention, blood transfusion, or ventilator support.
Results:
Of 16,209 children, 19% were admitted to the PICU: mean age 7.3years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6years, p<0.001) with a lower median ISS (16 vs. 21, p<0.001), shorter median PICU LOS (17 vs. 41h, p<0.001) and shorter median hospital LOS (51 vs. 121h, p<0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury.
Conclusions:
A significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.
