title: Unplanned admissions to a pediatric cardiac critical care unit: a review of 2 years' experience.
abstract: OBJECTIVE
  Unplanned admissions to the pediatric cardiac ICU may be a large and high-risk group. Our study describes the frequency of unplanned pediatric cardiac ICU admissions, their admission data, and outcomes.
  
  
  METHODS
  All admissions to a pediatric cardiac ICU over 2 years were reviewed and those that were unplanned were identified for a detailed chart abstraction. Demographic, laboratory, diagnostic, and outcome data were collected. Readmission or admission for adverse event was noted.
  
  
  METHODS
  Single, tertiary, pediatric cardiac center.
  
  
  METHODS
  All patients admitted unexpectedly to the pediatric cardiac critical care unit between May 2008 and May 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were 1,203 admissions to the cardiac ICU, and 426 (35%) were unplanned. The most common reasons for admission were new heart disease (25%), infection (19%), arrhythmia (13%), and congestive heart failure (11%). The majority of unplanned admissions (62%) occurred at night. Shock was present at admission in 18.5% of patients. Structural heart disease was present in 79%, and 39% of those were patients with single ventricle. Overall mortality among unplanned admissions was 7.3%, which is higher than that reported for elective surgical admissions. Mortality for the subset of patients readmitted within 30 days was 5.5%. Mean creatinine at admission was higher among nonsurvivors (0.7) than survivors (0.5).
  
  
  CONCLUSIONS
  Unplanned admissions accounted for over one third of all admissions and had a high mortality rate. The majority of these occur at night, which may affect staffing models. Acute deterioration leading to unplanned admission, rather than readmission status, may be the driving factor in increased mortality. However, the risk of readmission, lower renal function, or other indices may identify patients at higher risk of an unplanned admission. Continued efforts to identify patients at risk for unplanned admissions are warranted given the outcomes in this cohort.
authors: 1Division of Cardiology, Advocate Children's Hospital, Oak Lawn, IL. 2Department of Pediatrics, Children's National Medical Center, Washington, DC. 3Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA. 4Division of Cardiology, Children's National Medical Center, Washington, DC. 5Division of Critical Care, Children's National Medical Center, Washington, DC.
authors: Jamie S
authors: JS
authors: Penk
authors: Yue-Hin
authors: YH
authors: Loke
authors: Kevin R
authors: KR
authors: Waloff
authors: Lowell H
authors: LH
authors: Frank
authors: David C
authors: DC
authors: Stockwell
authors: Michael C
authors: MC
authors: Spaeder
authors: John T
authors: JT
authors: Berger
mesh_terms: D002675:Child, Preschool; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004219:District of Columbia; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data