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Risk Factors of Readmission to Pediatric Intensive Care Unit Within 1 Year: A Case-Control Study
Min Ding1, Chunfeng Yang1, Yumei Li1
1Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.
Insights
Pediatric intensive care unit (PICU) readmission in China is linked to chronic conditions, high malnutrition risk scores, and prolonged PICU stays. Identifying these factors can help reduce readmission rates and improve outcomes for children after PICU discharge.
Area of Science:
- Pediatric critical care medicine
- Healthcare outcomes research
Background:
- Research on pediatric intensive care unit (PICU) readmission in China is limited.
- Understanding readmission risk factors is crucial for improving pediatric patient care and resource allocation.
Purpose of the Study:
- To identify risk factors associated with pediatric intensive care unit (PICU) readmission within one year of discharge.
- To inform strategies for preventing readmissions and enhancing post-PICU care for children in China.
Main Methods:
- Retrospective case-control study of patients aged 1 month to 16 years discharged between January 2018 and May 2020.
- Case group: patients with ≥2 PICU admissions within 1 year; Control group: survivors with 1 PICU admission, matched for age and sex.
- Analysis of demographic and clinical variables using univariate and multivariate methods.
Main Results:
- A total of 2,529 patients were discharged, with 103 (4.07%) readmitted within 1 year.
- Significant risk factors for 1-year readmission included chronic conditions, higher StrongKids score (indicating malnutrition risk), and PICU stay >2 weeks.
- Factors for readmission within 48 hours included chronic conditions, higher StrongKids score, and vasopressor use.
Conclusions:
- Chronic conditions, elevated StrongKids score on admission, and prolonged PICU stay (>2 weeks) are key predictors of 1-year PICU readmission.
- Vasopressor use during the first PICU stay increases the risk of readmission within 48 hours.
- These findings highlight critical areas for intervention to reduce pediatric readmissions.
Background:
Research on pediatric intensive care unit (PICU) readmission is lacking in China. This study was conducted to describe the risk factors associated with PICU readmission within 1 year after PICU discharge.
Methods:
This retrospective case-control study included patients aged from 1 month to 16 years who were discharged between January 2018 and May 2020. The case group included readmitted patients with two or more PICU admissions within 1 year during the study period. The control group included survivors with only one PICU admission during the same study period, and the controls were matched on age and sex. Demographic and clinical variables were collected from the electronic administrative database. Risk factors were analyzed by univariate and multivariate analyses.
Results:
From January 2018 to May 2020, 2,529 patients were discharged from the PICU, and 103 (4.07%) were readmitted within 1 year. In the univariate analysis, PICU readmission within 1 year was associated with lower weight, the presence of chronic conditions, a higher StrongKids score on admission, length of PICU stay of more than 2 weeks, the presence of dysfunction at discharge, sedation medications use, vasopressor use, and invasive mechanical ventilation in the first PICU stay. Patients had a higher StrongKids score as a surrogate for increased risk of malnutrition. In the multivariate analysis, the factors most significantly associated with PICU readmission within 1 year were the presence of chronic conditions, a higher StrongKids score on admission, and length of PICU stay of more than 2 weeks in the first PICU stay. In the subgroup analysis, compared with the control group, the factors most significantly associated with readmission within 48 h of discharge were the presence of chronic conditions, a higher StrongKids score on admission, and vasopressor use during the first PICU stay. The mortality rate was 8.74% (9/103) in patients with PICU readmission. The overall PICU mortality rate was 7.39% (201/2,721) during the study period.
Conclusions:
Patients with chronic conditions, a higher StrongKids score on admission, and length of PICU stay of more than 2 weeks were at much higher risk for PICU readmission within 1 year. Patients with vasopressor use during the first PICU hospitalization were more likely to be readmitted within 48 h of discharge.
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