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Readmission and Late Mortality After Critical Illness in Childhood
Mary E Hartman1, Mohammed J Saeed, Tellen Bennett
11Department of Pediatric Intensive Care, Washington University in St. Louis, St. Louis, MO. 2Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, MO. 3Pediatric Critical Care, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. 4Department of Pediatrics, University of Arizona, Tucson, AZ. 5San Antonio Military Medical Center, United States Air Force, San Antonio, TX. 6Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO.
Insights
Hospital readmission after pediatric intensive care unit (PICU) care is common, especially for children with longer PICU stays. Late mortality risk is significantly elevated compared to the general pediatric population.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Epidemiology
Background:
- Limited understanding of post-discharge mortality and healthcare utilization in U.S. children after intensive care unit (ICU) hospitalization.
- Need to assess risks for hospital readmission and mortality trends in the year following pediatric ICU discharge.
Purpose of the Study:
- To investigate the risks of hospital readmission and mortality trends in children within one year after ICU discharge.
- To identify factors associated with nonelective readmission in this pediatric population.
Main Methods:
- Retrospective observational cohort study using administrative claims data (2006-2013).
- Inclusion of all U.S. children (≤18 years) admitted to an ICU.
- Analysis of nonelective readmission and mortality using Cox proportional hazards models.
Main Results:
- 109,130 children identified with ICU admissions; 78.6% had ICU stays ≤3 days.
- Nonelective readmission risk increased with longer ICU stays, younger age, and presence of chronic/acute conditions.
- 36.0% readmission rate for children with ICU stays ≥14 days vs. 13.9% for those with 1-day stays.
- Late mortality was low overall but 10-fold higher in children with initial ICU stays ≥14 days.
Conclusions:
- Hospital readmission is a frequent outcome for children after ICU care.
- Further research is needed to identify modifiable factors influencing readmission.
- Late mortality, while uncommon overall, poses a significantly higher risk for certain pediatric ICU survivors compared to the general pediatric population.
Objectives:
Little is known about the ongoing mortality risk and healthcare utilization among U.S. children after discharge from a hospitalization involving ICU care. We sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge.
Design:
Retrospective observational cohort study.
Setting:
This study was performed using administrative claims data from 2006-2013 obtained from the Truven Health Analytics MarketScan Database.
Subjects:
We included all children in the dataset admitted to a U.S. ICU less than or equal to 18 years old.
Interventions:
The primary outcome was nonelective readmission in the year following discharge. Risk of rehospitalization was determined using a Cox proportional hazards model.
Measurements And Main Results:
We identified 109,130 children with at least one ICU admission in the dataset. Over three quarters of the index ICU admissions (78.6%) had an ICU length of stay less than or equal to 3 days, and the overall index hospitalization mortality rate was 1.4%. In multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. By the end of the 1-year observation period, 36.0% of children with an index ICU length of stay greater than or equal to 14 days had been readmitted, compared with only 13.9% of children who had an index ICU length of stay equals to 1 day. Mortality in the year after ICU discharge was low overall (106 deaths per 10,000 person-years of observation) but was high among children with an initial index ICU admission length of stay greater than or equal to 14 days (599 deaths per 10,000 person-years).
Conclusions:
Readmission after ICU care is common. Further research is needed to investigate the potentially modifiable factors affecting likelihood of readmissions after discharge from the ICU. Although late mortality was relatively uncommon overall, it was 10-fold higher in the year after ICU discharge than in the general U.S. pediatric population.
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