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The Association Between Admission Sources and Outcomes at a Pediatric Intensive Care Unit in Al-Ahsa, Saudi Arabia: A
Sajjad M AlKadhem1, Sami AlKhwaitm2, Ahmed Z Alkhars3
1Pediatrics, Maternity and Children Hospital Al-Ahsa, Al-Ahsa, SAU.
Insights
Pediatric intensive care unit (PICU) admissions from the emergency department (ED) are linked to lower mortality and shorter hospital stays compared to intra-hospital transfers. Patient age and admission timing also predict outcomes in PICU patients.
Area of Science:
- Pediatric Critical Care Medicine
- Health Services Research
Background:
- Understanding factors influencing outcomes in pediatric intensive care units (PICUs) is crucial for improving patient care.
- The source of admission (e.g., emergency department vs. intra-hospital transfer) may impact patient outcomes.
Purpose of the Study:
- To investigate the association between admission source (emergency department vs. intra-hospital transfer) and outcomes in PICU patients.
- To identify independent predictors of discharge and mortality rates in a pediatric intensive care population.
Main Methods:
- Retrospective cohort study analyzing data from 2,547 patients admitted to a PICU between January 1, 2016, and December 31, 2018.
- Inclusion criteria: patients aged 0-14 years with a specific diagnosis, recorded admission source, and clear outcome.
- Statistical analysis performed using SPSS and STATA software.
Main Results:
- Infants had a higher risk of prolonged hospital stay and mortality compared to older children.
- Neonates showed an increased risk of mortality.
- Patients admitted via the emergency department (ED) had a lower risk of prolonged stay and mortality compared to intra-hospital transfers.
- Specific admission time periods were associated with lower mortality risk compared to October-December.
Conclusions:
- Patient age, source of admission, and admission date are potential independent predictors of PICU admission outcomes.
- These factors can inform risk stratification and management strategies for critically ill children.
Abstract:
Objectives In this study, we aimed to examine the association between sources of admission (either intra-hospital transfers or ED admissions) in pediatric intensive care units (PICUs) and the discharge rate, mortality rate, and referral over a period of three years. We also sought to identify the independent predictors of discharge and mortality rate in the study population. Patients and methods This was a retrospective cohort study involving the analysis of 2,547 patients' data collected from the Pediatric Intensive Care Registry of a secondary care community hospital. We included patients admitted to the PICU from January 1, 2016, till December 31, 2018, who were aged 0-14 years with a specific diagnosis, recorded source of admission, and clear outcome. Data were collected, coded, and analyzed using the SPSS Statistics software (IBM, Armonk, NY) and STATA software (StataCorp, College Station, TX). Results Of the included patients, 1,356 (53.2%) were males, and 1,191 (46.8%) were females. Infants were associated with an increased risk of a long stay in the hospital [relative risk ratio (RRR)=5.34, 95% CI: (1.28, 22.27)] and mortality [RRR=3.56, 95% CI: (1.41, 8.95)] compared to older children. Similarly, neonates were associated with a higher risk of mortality [RRR=2.83, 95% CI: (1.05, 7.65)]. Patients who were admitted through ED were associated with a lower risk of a long-stay [RRR=0.56, 95% CI: (10.36, 0.87)] and mortality [RRR=0.68, 95% CI: (0.49, 0.95)] compared to intra-hospital transfers. Concerning the admission date, all time periods were associated with a lower risk of mortality compared to the period of October-December. Conclusion Our findings showed that the age of patients, source of admission, and date of admission might be used as independent predictors for determining the outcome of admissions, including discharge and mortality rates. Further studies are required to confirm these findings.
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