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Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
Huan Liang1, Kyle A Carey2, Priti Jani3
1Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States.
Insights
Critical events within 48 hours of pediatric intensive care unit (PICU) transfer, including mechanical ventilation or vasoactive infusions, significantly increase mortality risk. This association highlights the importance of monitoring these critical events (CEs) for evaluating quality improvement initiatives in pediatric care.
Area of Science:
- Pediatric critical care medicine
- Clinical outcomes research
- Healthcare quality improvement
Background:
- Critical deterioration in hospitalized children, defined by transfer to the pediatric intensive care unit (PICU) followed by mechanical ventilation (MV) or vasoactive infusion (VI) within 12 hours, is a key metric for evaluating interventions.
- Understanding the association between critical events (CEs) post-PICU transfer and mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To explore the association between critical events (CEs) within 48 hours of PICU transfer and in-hospital mortality in children.
- To determine if the timing of CEs (within 12 hours vs. 12-48 hours) influences mortality risk.
Main Methods:
- A retrospective cohort study was conducted at two tertiary-care academic hospitals.
- Data from PICU transfers from the ward or emergency department (ED) were analyzed.
- The association between CEs (MV or VI) within 48 hours of PICU transfer and mortality was assessed, adjusting for age, gender, hospital, and comorbidities.
Main Results:
- Experiencing a CE within 48 hours of PICU transfer was significantly associated with increased mortality risk (OR 12.40).
- The highest mortality risk was observed within the first 12 hours post-transfer (OR 11.32), with a persistent increased risk between 12-48 hours (OR 2.84).
- Risk varied based on transfer origin (ED vs. ward), age groups, and specific 12-hour intervals.
Conclusions:
- Occurrence of a critical event within 48 hours of PICU transfer is a significant predictor of mortality in hospitalized children, even after adjusting for confounders.
- Critical events within 48 hours of PICU transfer can serve as a valuable metric for evaluating the effectiveness of quality improvement initiatives in pediatric care.
Introduction:
Critical deterioration in hospitalized children, defined as ward to pediatric intensive care unit (PICU) transfer followed by mechanical ventilation (MV) or vasoactive infusion (VI) within 12 h, has been used as a primary metric to evaluate the effectiveness of clinical interventions or quality improvement initiatives. We explore the association between critical events (CEs), i.e., MV or VI events, within the first 48 h of PICU transfer from the ward or emergency department (ED) and in-hospital mortality.
Methods:
We conducted a retrospective study of a cohort of PICU transfers from the ward or the ED at two tertiary-care academic hospitals. We determined the association between mortality and occurrence of CEs within 48 h of PICU transfer after adjusting for age, gender, hospital, and prior comorbidities.
Results:
Experiencing a CE within 48 h of PICU transfer was associated with an increased risk of mortality [OR 12.40 (95% CI: 8.12-19.23, P < 0.05)]. The increased risk of mortality was highest in the first 12 h [OR 11.32 (95% CI: 7.51-17.15, P < 0.05)] but persisted in the 12-48 h time interval [OR 2.84 (95% CI: 1.40-5.22, P < 0.05)]. Varying levels of risk were observed when considering ED or ward transfers only, when considering different age groups, and when considering individual 12-h time intervals.
Discussion:
We demonstrate that occurrence of a CE within 48 h of PICU transfer was associated with mortality after adjusting for confounders. Studies focusing on the impact of quality improvement efforts may benefit from using CEs within 48 h of PICU transfer as an additional evaluation metric, provided these events could have been influenced by the initiative.
