title: Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs.
abstract: OBJECTIVE
  To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems.
  
  
  METHODS
  One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed.There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0-3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002).
  
  
  CONCLUSIONS
  Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.
authors: 1Division of Pediatric Critical Care, Columbia University College of Physician and Surgeons, New York, NY. 2Department of Mathematics, Mills College, Oakland, CA. 3Columbia University School of Nursing, Columbia University, New York, NY. 4Center for Health Policy, Columbia University, New York, NY. 5Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. 6Department of Medicine, University of California, San Francisco, CA. 7Division of Pulmonary and Critical Care, University of California, San Francisco, CA. 8Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
authors: Jeffrey D
authors: JD
authors: Edwards
authors: Adam R
authors: AR
authors: Lucas
authors: Patricia W
authors: PW
authors: Stone
authors: W John
authors: WJ
authors: Boscardin
authors: R Adams
authors: RA
authors: Dudley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
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