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Intensive care unit admission predicts hospital readmission in pediatric trauma
Hibbut-Ur-Rauf Naseem1, Robert Michael Dorman2, Kathryn D Bass2
1Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York.
Insights
Pediatric intensive care unit (PICU) admission for trauma patients increases the risk of hospital readmission. Direct or delayed PICU admission independently predicts readmission within 30 days, highlighting a need for targeted interventions.
Area of Science:
- Pediatric Trauma Care
- Healthcare Outcomes Research
- Critical Care Medicine
Background:
- Hospital readmissions in adult trauma patients are linked to increased morbidity, mortality, and resource use.
- Pediatric trauma readmissions require investigation into associated risk factors.
- Pediatric intensive care unit (PICU) admission is examined as a potential risk factor for pediatric trauma readmissions.
Purpose of the Study:
- To investigate the association between pediatric intensive care unit (PICU) admission and hospital readmission in pediatric trauma patients.
- To determine if direct or delayed PICU admission impacts readmission rates.
- To identify risk factors for 30-day hospital readmissions following pediatric trauma care.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database.
- Inclusion of patients aged 1-19 years discharged with a trauma diagnosis.
- Analysis of patient demographics, clinical variables, length of stay, comorbidities, mechanical ventilation, severity of illness, and discharge disposition to predict 30-day readmission.
Main Results:
- Out of 90,467 trauma patients, 18.0% were admitted to the PICU, with an overall readmission rate of 3.1%.
- Patients with direct or delayed PICU admission had a significantly higher risk of readmission (4.8% and 7.2%, respectively) compared to those never admitted to the PICU (2.7%).
- Multivariate analysis confirmed that direct PICU admission (adjusted OR 1.34) and delayed PICU admission (adjusted OR 1.88) are independent risk factors for 30-day hospital readmission.
Conclusions:
- Pediatric intensive care unit (PICU) admission, whether direct or delayed, is an independent risk factor for hospital readmission within 30 days for pediatric trauma patients.
- These findings suggest that PICU admission is a significant predictor of readmission.
- Further risk stratification and targeted interventions for high-risk PICU-admitted trauma patients may improve outcomes and reduce readmissions.
Background:
Hospital readmission in adult trauma is associated with significant morbidity, mortality, and resource utilization. In this study, we examine pediatric intensive care unit (PICU) admission as a risk factor for hospital readmission in pediatric trauma.
Materials And Methods:
This was a retrospective cohort study of patients aged 1 through 19 y in the Pediatric Health Information System database discharged with a trauma diagnosis. Patient and clinical variables included demographics, payer status, length of stay, chronic comorbid conditions, presence of mechanical ventilation, all-patient refined diagnosis-related group and calculated severity of illness, and discharge disposition. The main outcome variable was hospital readmission within 30 d of discharge. Odds ratios (ORs) were calculated in both univariate and multivariate analyses with corresponding 95% confidence intervals (CIs).
Results:
During the 5-year study period, 90,467 patients were admitted with a trauma diagnosis, of which 16,279 (18.0%) were admitted to the PICU. Hospital readmissions occurred in 3.1% of patients. On univariate analysis, patients admitted to the PICU on the first day of hospital admission (direct PICU admission), and those first admitted to the PICU after the day of hospital admission (delayed PICU admission), had 2-3 times the risk of hospital readmission compared with those never admitted to the PICU (4.8% versus 7.2% versus 2.7%, respectively, P < 0.001). On multivariate analysis, controlling for demographic and clinical variables, the adjusted ORs for hospital readmission in patients with direct and delayed PICU admission were 1.34 (95% CI 1.20-1.50) and 1.88 (95% CI 1.50-2.35) versus no PICU admission, respectively.
Conclusions:
PICU admission, either direct or delayed, during hospitalization for trauma care is an independent risk factor for hospital readmission within 30 d of discharge. Further risk stratification may help focus resources on high-risk patients to improve clinical outcomes and reduce readmissions.
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