title: Characteristics and outcomes of interhospital transfers from level II to level I pediatric intensive care units.
abstract: OBJECTIVE
  To examine the characteristics, resource utilization, and outcomes for transfer admissions from level II to level I pediatric intensive care units (PICUs).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A 16-bed level I PICU in a tertiary care children's hospital.
  
  
  METHODS
  All transfer admissions from level II PICUs from January 1, 1997, through December 31, 2003; admissions for cardiac surgery were excluded. Patient characteristics, resource utilization, and outcomes were described and then compared across predefined strata (low <5%, moderate 5-30%, and high >30%) of predicted probability of death.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 168 transfer admissions, 45%, 30%, and 25% were in the low, moderate, and high mortality risk groups, respectively. Length of stay at the referring PICU was shortest for the high-risk admissions. The most frequent diagnoses among all risk groups were respiratory failure (49%) and sepsis (14%). High-risk admissions were more likely to receive advanced therapies such as extracorporeal membrane oxygenation (41.5% high risk vs. 39.2% moderate vs. 6.6% low risk, p < .01) and renal replacement therapy (34.2% vs. 17.7% vs. 2.6%, p < .01). The high-risk admissions had longer PICU length of stay and the highest death rates (34% vs. 10% vs. 4%, p < .01) when compared with the moderate- and low-risk admissions, respectively.
  
  
  CONCLUSIONS
  This study highlights significant differences in patient characteristics, resource utilization, and outcomes across mortality risk-stratified groups of critically ill and injured children transferred from level II to level I PICU care. Further studies are warranted to investigate decision making that prompt inter-PICU transfers.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shanley
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Dechert
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome