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PROPER: Development of an Early Pediatric Intensive Care Unit Readmission Risk Prediction Tool
Harsheen Kaur1, James M Naessens2, Andrew C Hanson2
11 Department of Pediatric Critical Care, Mayo Clinic, Rochester, MN, USA.
Insights
A new risk score, PRediction Of PICU Early Readmissions (PROPER), effectively identifies pediatric patients at high risk for early readmission to the pediatric intensive care unit (PICU). The adult SWIFT score is not suitable for this population.
Area of Science:
- Pediatric Intensive Care
- Clinical Risk Prediction
- Patient Outcomes
Background:
- No validated risk prediction model exists for pediatric intensive care unit (PICU) readmissions.
- Adult risk scores may not translate to pediatric populations.
Purpose of the Study:
- Assess the applicability of the adult Stability and Workload Index for Transfer (SWIFT) score in predicting PICU readmissions.
- Develop a pediatric-specific risk prediction model for early PICU readmissions.
Main Methods:
- Retrospective case-control study comparing 86 early PICU readmissions with 170 controls.
- Multivariate analysis identified significant factors for risk model creation.
- Validated the adult SWIFT score and developed the pediatric PRediction Of PICU Early Readmissions (PROPER) score.
Main Results:
- Readmitted patients were younger, had lower weight, and higher rates of moderate to severe disability.
- The adult SWIFT score showed poor discrimination (AUC: 0.613).
- The 7-category PROPER score demonstrated 81% sensitivity and 0.50 positive predictive value for detecting readmissions.
Conclusions:
- The PROPER score is a preliminary, effective tool for identifying pediatric patients at risk of early PICU readmission.
- The adult SWIFT score is not applicable for predicting PICU readmission risk in children.
Objective:
No risk prediction model is currently available to measure patient's probability for readmission to the pediatric intensive care unit (PICU). This retrospective case-control study was designed to assess the applicability of an adult risk prediction score (Stability and Workload Index for Transfer [SWIFT]) and to create a pediatric version (PRediction Of PICU Early Readmissions [PROPER]).
Design:
Eighty-six unplanned early (<48 hours) PICU readmissions from January 07, 2007, to June 30, 2014, were compared with 170 random controls. Patient- and disease-specific data and PICU workload factors were compared across the 2 groups. Factors statistically significant on multivariate analysis were included in the creation of the risk prediction model. The SWIFT scores were calculated for cases and controls and compared for validation.
Results:
Readmitted patients were younger, weighed less, and were more likely to be admitted from the emergency department. There were no differences in gender, race, or admission Pediatric Index of Mortality scores. A higher proportion of patients in the readmission group had a Pediatric Cerebral Performance Category in the moderate to severe disability category. Cases and controls did not differ with respect to staff workload at discharge or discharge day of the week; there was a much higher proportion of patients on supplemental oxygen in the readmission group. Only 2 of 5 categories in the SWIFT model were significantly different, and although the median SWIFT score was significantly higher in the readmissions group, the model discriminated poorly between cases and controls (area under the curve: 0.613). A 7-category PROPER score was created based on a multiple logistic regression model. Sensitivity of this model (score ≥12) for the detection of readmission was 81% with a positive predictive value of 0.50.
Conclusion:
We have created a preliminary model for predicting patients at risk of early readmissions to the PICU from the hospital floor. The SWIFT score is not applicable for predicting the risk for pediatric population.
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