Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center.
BACKGROUND
No formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center.


METHODS
The trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30h without surgical intervention, blood transfusion, or ventilator support.


RESULTS
Of 16,209 children, 19% were admitted to the PICU: mean age 7.3years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6years, p<0.001) with a lower median ISS (16 vs. 21, p<0.001), shorter median PICU LOS (17 vs. 41h, p<0.001) and shorter median hospital LOS (51 vs. 121h, p<0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury.


CONCLUSIONS
A significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.
Division of Pediatric Surgery, University of Utah School of Medicine. Electronic address: stephen.fenton@hsc.utah.edu.
Stephen J
SJ
Fenton
University of Utah School of Medicine. Electronic address: stephen.campbell@hsc.utah.edu.
Stephen J
SJ
Campbell
Division of Pediatric Surgery, University of Utah School of Medicine. Electronic address: austin.stevens@hsc.utah.edu.
Austin M
AM
Stevens
Division of Epidemiology, University of Utah School of Medicine. Electronic address: chong.zhang@hsc.utah.edu.
Chong
C
Zhang
Division of Epidemiology, University of Utah School of Medicine. Electronic address: angela.presson@hsc.utah.edu.
Angela P
AP
Presson
Division of Pediatric Surgery, University of Illinois at Chicago. Electronic address: jlee83@uic.edu.
Justin H
JH
Lee
D002648:Child; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*
Intensive care unit; Pediatric; Trauma