title: Unscheduled Pediatric Intensive Care Unit Admissions in Patients With Cardiovascular Disease: Clinical Features and Outcomes.
abstract: An unscheduled readmission to the intensive care unit (ICU) is associated with increased morbidity and mortality in children. There is a paucity of data examining the impact of unscheduled admissions on outcomes in children with specific disease processes such as cardiovascular disease. We investigated the impact of scheduled versus unscheduled ICU admission on clinical outcomes and differences in patient characteristics in children with cardiovascular disease.
  
  
  
  This was a retrospective analysis of contemporaneously collected clinical data using the Virtual PICU Systems database. All consecutive admissions at 102 participating pediatric ICUs in patients with cardiovascular disease were collected from October 2010 to September 2012.
  
  
  
  There were 48,653 admissions included in the analysis (44% scheduled and 56% unscheduled). The median patient age was 31 months. Unscheduled admissions were associated with longer ICU length of stay and increased mortality (both P < .001). Adjusting for age, weight, and primary ICU admission diagnosis (cardiovascular vs noncardiovascular), patients with unscheduled admissions had an increased odds of mortality (odds ratio = 4.8, P < .001).
  
  
  
  Unscheduled ICU admissions were associated with worse clinical outcomes including increased mortality. Efforts targeted at reducing unscheduled admissions in at-risk patients are warranted.
authors.affiliation: Division of Critical Care Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA melinda-coro@uiowa.edu.
authors.forename: Melinda D
authors.initials: MD
authors.lastname: Coro
authors.affiliation: Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.affiliation: Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Penk
authors.affiliation: Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Levin
authors.affiliation: Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Futterman
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies
keywords: cardiac disease; intensive care unit; mortality; mortality rate; outcomes research; unscheduled admissions