title: Long-stay patients in the pediatric intensive care unit.
abstract: OBJECTIVE
  Length of stay in the pediatric intensive care unit (PICU) is a reflection of patient severity of illness and health status, as well as PICU quality and performance. We determined the clinical profiles and relative resource use of long-stay patients (LSPs) and developed a prediction model to identify LSPs for early quality and cost saving interventions.
  
  
  METHODS
  Nonconcurrent cohort study.
  
  
  METHODS
  A total of 16 randomly selected PICUs and 16 volunteer PICUs.
  
  
  METHODS
  A total of 11,165 consecutive admissions to the 32 PICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  LSPs were defined as patients having a length of stay greater than the 95th percentile (>12 days). Logistic regression analysis was used to determine which clinical characteristics, available within the first 24 hrs after admission, were associated with LSPs and to create a predictive algorithm. Overall, LSPs were 4.7% of the population but represented 36.1% of the days of care. Multivariate analysis indicated that the following factors are predictive of long stays: age <12 months, previous ICU admission, emergency admission, no CPR before admission, admission from another ICU or intermediate care unit, chronic care requirements (total parenteral nutrition and tracheostomy), specific diagnoses including acquired cardiac disease, pneumonia, and other respiratory disorders, having never been discharged from the hospital, need for ventilatory support or an intracranial catheter, and a Pediatric Risk of Mortality III score between 10 and 33. The performance of the prediction algorithm in both the training and validation samples for identifying LSPs was good for both discrimination (area under the receiver operating characteristics curve of 0.83 and 0.85, respectively), and calibration (goodness of fit, p = .33 and p = .16, respectively). LSPs comprised from 2.1% to 8.1% of individual ICU patients and occupied from 15.2% to 57.8% of individual ICU bed days.
  
  
  CONCLUSIONS
  LSPs have less favorable outcomes and use more resources than non-LSPs. The clinical profile of LSPs includes those who are younger and those that require chronic care devices. A predictive algorithm could help identify patients at high risk of prolonged stays appropriate for specific interventions.
authors.affiliation: Section of Critical Care Medicine, Department of Pediatrics, University of California, Davis, Sacramento, CA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Marcin
authors.forename: A D
authors.initials: AD
authors.lastname: Slonim
authors.forename: M M
authors.initials: MM
authors.lastname: Pollack
authors.forename: U E
authors.initials: UE
authors.lastname: Ruttimann
mesh_terms: D017677:Age Distribution; D000465:Algorithms; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D017046:Cost Savings; D003422:Critical Care / Q000191:economics / Q000592:standards*; D003663:Decision Trees; D016002:Discriminant Analysis; D004630:Emergencies; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011787:Quality of Health Care; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology