title: Association between Hospital Volume and Within-Hospital Intensive Care Unit Transfer for Sickle Cell Disease in Children's Hospitals.
abstract: OBJECTIVE
  To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD).
  
  
  METHODS
  We conducted a retrospective cohort study of 83,477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS.
  
  
  RESULTS
  Of 83,477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS.
  
  
  CONCLUSIONS
  Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: Raphael@bcm.edu.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.
authors.forename: Suzette O
authors.initials: SO
authors.lastname: Oyeku
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.affiliation: Department of Pediatrics, The Children's Mercy Hospital and Clinics, Kansas City, MO.
authors.forename: Ram V
authors.initials: RV
authors.lastname: Kalpatthi
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Ellison
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology