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Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs
Jeffrey D Edwards1, Adam R Lucas, W John Boscardin
11Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY.2Department of Statistics, University of California, Berkeley, CA.3Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.4Department of Medicine, University of California, San Francisco, San Francisco, CA.5Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA.6Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
Insights
Unplanned readmissions to pediatric intensive care units (PICUs) affect 11% of patients, with complex chronic conditions significantly increasing readmission risk. These readmissions are linked to higher mortality and longer PICU stays.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Epidemiology
Background:
- Unplanned readmissions pose a significant challenge in pediatric intensive care units (PICUs).
- Understanding the rates and risk factors for PICU readmissions is crucial for improving patient outcomes and resource allocation.
Purpose of the Study:
- To determine the incidence of unplanned readmissions to PICUs within one year of discharge.
- To identify risk factors associated with repeated unplanned readmissions in pediatric patients.
Main Methods:
- Retrospective cohort analysis of 93,379 PICU patients discharged between 2009 and 2010 from 76 North American PICUs.
- Time-to-event analyses were employed to examine factors associated with 1-year readmission.
- Comparison of outcomes between index admissions and unplanned readmissions.
Main Results:
- Eleven percent of patients experienced 15,625 unplanned readmissions within one year; 3.4% had two or more readmissions.
- Readmissions were associated with significantly higher PICU mortality (4.0% vs 2.5%) and longer PICU length of stay (2.5 vs 1.6 days).
- Complex chronic conditions were strongly associated with earlier readmission, with increasing numbers of conditions escalating the risk.
Conclusions:
- Unplanned PICU readmissions represent a substantial issue, affecting a considerable proportion of pediatric patients.
- Patients with complex chronic conditions, particularly specific ones, face a markedly elevated risk of unplanned readmission, necessitating targeted interventions.
Objectives:
To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.
Design:
Retrospective cohort analysis.
Setting:
Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).
Patients:
Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.
Interventions:
None.
Measurements And Main Results:
Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.
Conclusions:
Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
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