Going back for more: an evaluation of clinical outcomes and characteristics of readmissions to a pediatric intensive care unit.
OBJECTIVE
To determine mortality, length of stay, and factors associated with readmissions to the pediatric intensive care unit (PICU).


METHODS
A retrospective analysis of prospectively collected data.


METHODS
A 16-bed medical-surgical tertiary PICU and a coexisting 15-bed pediatric cardiac intensive care unit.


METHODS
All admissions from July 1, 1998, through June 30, 2004.


METHODS
None.


RESULTS
Of 8,885 total eligible admissions, 711 (8%) were readmissions to the PICU. The median age of the overall cohort was 35.2 months (interquartile range, 5.5-128.2). Readmitted patients were younger (10.4 vs. 37.7 months, p < .01), had greater severity of illness (p < .01), and were more likely to be admitted emergently (p < .01), in comparison with single admissions. In multivariate analyses, readmitted patients had a trend toward higher odds of mortality (odds ratio, 1.39; 95% confidence interval, 0.98-1.98) and stayed 2.96 days longer in the PICU (95% confidence interval, 1.98-3.94) compared with single admissions to the PICU. Factors independently associated with PICU readmission were infant age (odds ratio, 1.98; 95% confidence interval, 1.57-2.49), emergent admission (odds ratio, 2.21; 95% confidence interval, 1.78-2.77), illness severity (odds ratio, 1.03; 95% confidence interval, 1.01-1.04), and time of the year between July and September (odds ratio, 1.52; 95% confidence interval, 1.20-1.93). A diagnosis of trauma was associated with low likelihood of PICU readmission (odds ratio, 0.30; 95% confidence interval, 0.18-0.50).


CONCLUSIONS
Patients readmitted to the PICU during the same hospitalization have significantly adverse outcomes. The study highlights important factors associated with PICU readmissions that can be incorporated into efforts to reduce mortality and resource utilization associated with readmission of critically ill children.
Odetola
Folafoluwa O
FO
Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA. fodetola@med.umich.edu
Clark
Sarah J
SJ
Dechert
Ronald E
RE
Shanley
Thomas P
TP
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D012720:Severity of Illness Index; D016896:Treatment Outcome