title: Factors associated with interhospital transfer of children with respiratory failure from level II to level I pediatric intensive care units.
abstract: OBJECTIVE
  Of all sources of admission to level I pediatric intensive care units (PICUs), interhospital transfer admissions from level II PICUs carry the highest mortality and resource use burden. We sought to investigate factors associated with transfer of children with respiratory failure from level II to level I PICUs.
  
  
  METHODS
  A case-control study was conducted among children with respiratory failure admitted to 6 level II PICUs between January 1, 1997, and December 31, 2007, with frequency matching of 466 nontransferred children (controls) to 187 transferred children (cases).
  
  
  RESULTS
  Among 653 children, transferred children were younger and had more comorbidities. After multivariable analysis, transferred children were more likely to have comorbidities (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.36-2.98) and receive escalated care including high-frequency ventilation (OR, 2.57; 95% CI, 1.04-6.37) and surfactant therapy (OR, 5.33; 95% CI, 1.35-21.0).
  
  
  CONCLUSIONS
  The study identified patient-level and process-of-care factors associated with transfer from level II to level I PICUs. These findings highlight the influence of escalated care on transfer decision making for critically ill children in respiratory failure.
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: fodetola@med.umich.edu.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.affiliation: Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.affiliation: Division of Epidemiology and Biostatistics, University of Memphis School of Public Health, Memphis, TN, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.affiliation: Division of Cardiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.affiliation: Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: DuBois
authors.affiliation: Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005260:Female; D006295:Health Resources; D006612:High-Frequency Ventilation / Q000379:methods; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010360:Patient Transfer / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*
keywords: Children; Critical illness; Patient transfer; Respiratory insufficiency; Therapeutics