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Published on: September 24, 2020
Risk factors for unplanned paediatric intensive care unit admission after anaesthesia-an international multicentre
Katherine L Taylor1,2, Helena Frndova3, Leah Szadkowski4
1Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Unplanned pediatric intensive care unit (ICU) admissions after anesthesia were shorter and more likely to involve mechanical ventilation. These admissions, primarily in young children for respiratory issues, showed no difference in mortality compared to other unplanned ICU admissions.
Area of Science:
- Pediatric critical care medicine
- Anesthesiology
- Health services research
Background:
- Unplanned intensive care unit (ICU) admissions are linked to adverse patient outcomes.
- Understanding the characteristics and outcomes of different unplanned ICU admission sources is crucial for improving patient safety.
Purpose of the Study:
- To compare the rate, resource utilization, and outcomes of pediatric patients urgently admitted to the ICU post-anesthesia with those from other unplanned ICU admission sources.
Main Methods:
- A secondary analysis of data from specialist pediatric hospitals in 7 countries was performed.
- Patients urgently admitted to the ICU post-anesthesia were matched with controls from other unplanned ICU admission sources.
- Statistical comparisons included Wilcoxon rank-sum test, chi-square/Fisher's exact test, and conditional logistic regression.
Main Results:
- Admissions post-anesthesia were more common in infants (<1 year) and for respiratory reasons.
- These admissions were shorter, occurred later in the day, and had higher rates of mechanical ventilation.
- No significant differences were observed in subsequent ICU admissions, severity of illness scores, or mortality between groups.
Conclusions:
- Unplanned ICU admissions post-anesthesia in pediatrics are characterized by young age, respiratory indications, later timing, and increased mechanical ventilation use.
- Despite these differences, post-anesthesia unplanned ICU admissions did not result in worse outcomes, including mortality, compared to other unplanned admissions.
Objectives:
Unplanned intensive care unit (ICU) admissions are associated with near-miss events, morbidity, and mortality. We describe the rate, resource utilization, and outcomes of paediatric patients urgently admitted directly to ICU post-anaesthesia compared to other sources of unplanned ICU admissions.
Methods:
We performed a secondary analysis of data from specialist paediatric hospitals in 7 countries. Patients urgently admitted to the ICU post-anaesthesia were combined and matched with 1 to 3 unique controls from unplanned ICU admissions from other locations by age and hospital. Demographic, clinical, and outcome variables were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables. The effect of admission sources on binary outcomes was estimated using univariable conditional logistic regression models with stratification by matched set of anaesthesia and non-anaesthesia admission sources.
Results:
Most admissions were <1 year of age and for respiratory reasons. Admissions post-anaesthesia were shorter, occurred later in the day, and were more likely to be mechanically ventilated. Admissions post-anaesthesia were less likely to have had a previous ICU admission (4.8% compared to 11%, P=0.032) or PIM 'high-risk diagnosis' (9.5% versus 17.2%, P=0.035) but there was no difference in the number of subsequent ICU admissions. There was no difference in the PIM severity of illness score and no mortality difference between the groups.
Conclusions:
Young children and respiratory indications dominated unplanned ICU admissions post-anaesthesia, which was more likely later in the day and with mechanical ventilation.
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