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Incidence and risk factors for readmission to a paediatric intensive care unit

Umi Konishi¹, Takeshi Hatachi², Ryo Ikebe¹

¹Registered Nurse, Department of Nursing, Osaka Women's and Children's Hospital, Osaka, Japan.

Nursing in Critical Care

|October 3, 2019

Insights

Unscheduled readmissions to paediatric intensive care units occur in 2.5% of cases. Addressing withdrawal syndrome, a modifiable risk factor, may improve patient outcomes and reduce readmissions.

Area of Science:

Pediatric Intensive Care
Patient Outcomes
Healthcare Management

Background:

Unscheduled readmissions to paediatric intensive care units (PICUs) can negatively impact patient outcomes.
Previous research has primarily focused on readmissions within 48 hours and identified unmodifiable risk factors.
Understanding incidence and risk factors for readmission within 7 days is crucial for improving care.

Purpose of the Study:

To determine the incidence of unscheduled readmissions to a PICU within 7 days of discharge.
To identify significant risk factors associated with these readmissions.

Main Methods:

Retrospective observational study of consecutive patients admitted to a tertiary hospital's PICU from 2012 to 2016.
Multivariable logistic regression analysis was used to identify risk factors for readmission within 7 days.

Main Results:

The incidence of unscheduled readmission within 7 days was 2.5% (60 of 2432 admissions).
Common causes for readmission included respiratory and cardiovascular issues.
Significant risk factors identified were unscheduled initial admission, admission from a general ward, and withdrawal syndrome during the initial PICU stay.

Conclusions:

The incidence of unscheduled PICU readmission within 7 days is relatively low.
Withdrawal syndrome is a potentially modifiable risk factor that may be targeted to reduce readmissions.
Careful discharge planning and follow-up are recommended for high-risk patients.

Read full analysis

Abstract

Background:

Unscheduled readmission to a paediatric intensive care unit can lead to unfavourable patient outcomes. Therefore, determining the incidence and risk factors is important. Previous studies on such readmissions have only focused on the first 48 hours after discharge and described the relative risk factors as unmodifiable.

Aim:

To identify the incidence and risk factors of unscheduled readmission to a paediatric intensive care unit within 7 days of discharge.

Design:

This was a retrospective observational study.

Methods:

Our study population comprised consecutive patients admitted to the paediatric intensive care unit of our tertiary hospital in Japan in 2012 to 2016. We determined the incidence of unscheduled readmission to the unit within 7 days of discharge and identified potential risk factors using multivariable logistic regression analysis.

Results:

Among the 2432 admissions (1472 patients), 60 admissions (2.5%, 44 patients) were followed by ≥1 unscheduled readmission. The median time to readmission was 3.5 days. The most common causes for readmission were respiratory issues and cardiovascular symptoms. The significant risk factors for readmission within 7 days of discharge were unscheduled initial admission (odds ratio [OR]: 3.02; 95% confidence interval [CI:] 1.45-6.31), admission from a general ward (OR: 5.13; 95% CI: 1.75-15.0), and withdrawal syndrome during the initial stay (OR: 3.95; 95% CI: 1.53-10.2).

Conclusions:

The incidence of unscheduled readmission within 7 days was not high (2.5%), and one of the three identified risk factors for readmissions (withdrawal syndrome) is potentially modifiable.

Relevance To Clinical Practice:

Appropriate treatment of withdrawal syndrome may reduce readmissions and improve patient outcomes. Although unscheduled initial admission and admission from general ward are not modifiable risk factors, careful discharge judgement and follow up after discharge from paediatric intensive care units for high-risk patients may be beneficial.

Keywords:

paediatric intensive care unit readmission withdrawal syndrome

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