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Predictors for Home Discharge and Need for Medical Care at Home in Paediatric ICU Patients: A Single-Centre
Misuzu Oyagi1,2, Shigeki Bamba1, Kohei Takashima3
1Department of Fundamental Nursing, Shiga University of Medical Science, Otsu, Japan.
Insights
Postoperative admission, lower heart rate, and absence of cardiopulmonary arrest predict successful home discharge for pediatric ICU patients. Length of ICU stay is associated with the need for home medical care.
Area of Science:
- Pediatric critical care medicine
- Nursing science
- Health services research
Background:
- Increasing numbers of children with medical complexity require home care post-intensive care unit (ICU) discharge.
- Smooth transitions necessitate early nursing interventions and family training for these children.
Purpose of the Study:
- To identify predictors of successful home discharge for pediatric ICU patients.
- To determine factors associated with the need for ongoing medical care at home.
- To utilize routine clinical data available at ICU admission for prediction.
Main Methods:
- Retrospective analysis of 131 pediatric patients (<16 years) admitted to the ICU.
- Logistic regression (univariate and multivariate) to identify predictors of home discharge.
- Receiver operating characteristic (ROC) analysis to determine heart rate cut-off values.
Main Results:
- Home discharge was predicted by postoperative admission, lower heart rate (<131 bpm), absence of pre-ICU cardiopulmonary arrest (CPA), and no mechanical ventilation within the first ICU hour.
- 62 patients did not require home medical care.
- Longer ICU length of stay was significantly associated with the need for home medical care.
Conclusions:
- Key clinical factors at ICU admission can predict successful home discharge for pediatric patients.
- Early identification of patients needing home medical care is crucial.
- Tailored nursing interventions and family support are vital for quality home care.
Background:
The number of children with medical complexity at home has been increasing. To facilitate a smooth transition to home care for these children after discharge from the intensive care unit (ICU), early nursing interventions and family training are essential.
Aim:
This study examined factors that predict home discharge and the need for medical care at home using routine clinical information at the time of ICU admission.
Study Design:
This study included paediatric patients under the age of 16 who were admitted to the ICU. Clinical data were extracted from medical records. Univariate and multivariate analyses were conducted using logistic regression to identify relevant factors. Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values.
Results:
One hundred and thirty-one patients were included, of whom 82 patients were discharged home. Multivariate analysis using logistic regression identified the following independent predictors of home discharge: postoperative admission (p = 0.024), lower heart rate at admission (p = 0.016), absence of cardiopulmonary arrest immediately before ICU admission (CPA) (p = 0.012) and no mechanical ventilation within the first hour of ICU admission (p = 0.044). ROC analysis for heart rate at admission yielded a cut-off value of 131 bpm (p = 0.039). A total of 62 patients did not require home medical care. Univariate logistic regression analysis identified length of ICU stay as a significant factor associated with the need for home medical care (p = 0.045).
Conclusions:
In paediatric ICU patients, postoperative admission, lower heart rate at admission, absence of pre-admission CPA and no mechanical ventilation predicted successful home discharge. The need for home medical care was significantly associated with length of ICU stay.
Relevance To Clinical Practice:
Early and appropriate nursing interventions can be considered for paediatric ICU patients and their families, leading to the provision of high-quality nursing care.
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