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Prevalence and Predictors of Home Discharge from the PICU
Leslie A Dervan1,2, Daniel Garros3, Waylon Howard4
1Division of Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
Insights
Approximately 23% of children go directly home from the pediatric intensive care unit (PICU). Predictors include prior home discharge and specific complex conditions, with significant center variability observed.
Area of Science:
- Pediatric critical care medicine
- Health services research
Background:
- Discharge directly home from the pediatric intensive care unit (PICU) is an emerging practice.
- The prevalence and predictors of this discharge pathway are not well-established.
Purpose of the Study:
- To determine the prevalence of direct home discharge from the PICU.
- To identify patient and center-level predictors associated with this discharge disposition.
Main Methods:
- A multicenter cohort study analyzed 612,471 admissions across 142 North American PICUs from January 2015 to June 2021.
- Logistic regression, clustered by patient and center, was used to identify predictors of direct home discharge.
- Exclusions included unclear discharge dispositions and repeat admissions.
Main Results:
- 23.1% of pediatric patients were discharged directly home from the PICU.
- Key predictors for direct home discharge included prior home discharge, age 2-5 years, surgical admissions, and complex respiratory or cardiovascular conditions.
- Higher odds ratios were observed for these factors, while larger center size was associated with a lower likelihood of direct home discharge.
Conclusions:
- Direct home discharge from the PICU is a common practice, occurring in about one in four children.
- Significant variability exists in the implementation of this discharge pathway across different centers.
- Identifying patient characteristics associated with direct home discharge can inform care pathways and resource allocation.
Importance:
Discharge directly home from PICU is increasingly described, but its prevalence and predictors are not known.
Objectives:
To describe the prevalence and predictors of discharge directly home from the PICU.
Design:
Cohort of admissions between January 1, 2015, and June 30, 2021.
Setting:
Multicenter study of 142 North American PICUs participating in Virtual Pediatric Systems dataset.
Participants:
Hospitalized children younger than 18 years admitted to a participating PICU who were discharged home either directly or after transfer to the acute care ward. We excluded admissions with unclear discharge disposition, and repeat admissions within a year.
Main Outcomes And Measures:
Demographic, PICU admission, and unit characteristics were measured according to discharge disposition. A multilevel adjusted logistic regression model, clustered by patient and center, was used to evaluate predictors of discharge directly home.
Results:
The cohort included 612,471 admissions (339,818 [55%] males), of which 141,427 (23.1%) were discharged directly home from the PICU. Across 142 sites, the proportion of those discharged directly home ranged from 3% to 100%. In adjusted models, predictors associated with discharge home included prior discharge home (odds ratio [OR], 30.77; 95% CI, 27.92-33.92), age 2-5 years (OR, 2.35; 95% CI, 2.08-2.66), surgical admission (OR, 2.68; 95% CI, 1.34-5.33), and respiratory (OR, 2.08; 95% CI, 1.64-2.63) and cardiovascular (OR, 1.56; 95% CI, 1.18-2.06) complex chronic conditions. Large center size was associated with a lower likelihood of discharge home (OR, 0.58; 95% CI, 0.49-0.69).
Conclusions And Relevance:
About one in four children are discharged directly home after a PICU admission. While the practice is common, there is a large variability between centers. Selected patients, including those with acute surgical admission and those with complex chronic respiratory and cardiovascular conditions, are more likely to go directly home from the PICU.
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