title: Unplanned Extubations in Children: Impact on Hospital Cost and Length of Stay.
abstract: OBJECTIVE
  To determine the attributable hospital cost, both operational and departmental, and length of stay associated with unplanned extubations in children admitted to PICU and cardiac ICU.
  
  
  METHODS
  Retrospective, matched case-control study.
  
  
  METHODS
  Forty-four-bed PICU and 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital.
  
  
  METHODS
  Cases with an unplanned extubation were retrospectively identified from July 2011 to March 2013. Controls were PICU and cardiac ICU patients admitted over the same time period and were matched at a ratio of 2:1 for age and diagnosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  Forty-eight unplanned extubations were analyzed. There were no differences in patient demographics between the two groups, except the control group had a higher severity of illness as illustrated by a larger Paediatric Index of Mortality II Risk of Mortality. Median total hospital costs were higher in those patients with unplanned extubations as compared with controls ($101,310 vs $64,618; p < 0.001). Patients with an unplanned extubation had longer median ICU length of stay (10 d vs 4.5 d; p < 0.001) and hospital length of stay (16.5 d vs 10 d, p < 0.001).
  
  
  CONCLUSIONS
  Pediatric patients with unplanned extubations have an associated increase in hospital costs ($36,692/case) and length of stay (6.5 d/case) as compared with age and diagnosis-matched controls. Further efforts are warranted to establish data-driven benchmarks and establishment of unplanned extubations as a critical metric for ICU quality.
authors.affiliation: 1Division of Cardiology, Boston Children's Hospital, Boston, MA 2Division of Critical Care, Children's National Health System, Washington, DC. 3Division of Quality Improvement, Children's National Health System, Washington, DC.
authors.forename: Dantin J
authors.initials: DJ
authors.lastname: Roddy
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: William
authors.initials: W
authors.lastname: Pastor
authors.forename: David C
authors.initials: DC
authors.lastname: Stockwell
authors.forename: Darren
authors.initials: D
authors.lastname: Klugman
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects / Q000191:economics*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003325:Coronary Care Units / Q000191:economics; D004180:Direct Service Costs; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics*; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies