Intensive care unit admission predicts hospital readmission in pediatric trauma.
Hospital readmission in adult trauma is associated with significant morbidity, mortality, and resource utilization. In this study, we examine pediatric intensive care unit (PICU) admission as a risk factor for hospital readmission in pediatric trauma.



This was a retrospective cohort study of patients aged 1 through 19 y in the Pediatric Health Information System database discharged with a trauma diagnosis. Patient and clinical variables included demographics, payer status, length of stay, chronic comorbid conditions, presence of mechanical ventilation, all-patient refined diagnosis-related group and calculated severity of illness, and discharge disposition. The main outcome variable was hospital readmission within 30 d of discharge. Odds ratios (ORs) were calculated in both univariate and multivariate analyses with corresponding 95% confidence intervals (CIs).



During the 5-year study period, 90,467 patients were admitted with a trauma diagnosis, of which 16,279 (18.0%) were admitted to the PICU. Hospital readmissions occurred in 3.1% of patients. On univariate analysis, patients admitted to the PICU on the first day of hospital admission (direct PICU admission), and those first admitted to the PICU after the day of hospital admission (delayed PICU admission), had 2-3 times the risk of hospital readmission compared with those never admitted to the PICU (4.8% versus 7.2% versus 2.7%, respectively, P < 0.001). On multivariate analysis, controlling for demographic and clinical variables, the adjusted ORs for hospital readmission in patients with direct and delayed PICU admission were 1.34 (95% CI 1.20-1.50) and 1.88 (95% CI 1.50-2.35) versus no PICU admission, respectively.



PICU admission, either direct or delayed, during hospitalization for trauma care is an independent risk factor for hospital readmission within 30 d of discharge. Further risk stratification may help focus resources on high-risk patients to improve clinical outcomes and reduce readmissions.
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York.
Hibbut-Ur-Rauf
HU
Naseem
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, University at Buffalo, State University of New York, Buffalo, New York. Electronic address: rmdorman@buffalo.edu.
Robert Michael
RM
Dorman
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, University at Buffalo, State University of New York, Buffalo, New York.
Kathryn D
KD
Bass
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, University at Buffalo, State University of New York, Buffalo, New York.
David H
DH
Rothstein
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
Clinical outcomes; PHIS; Pediatric; Readmission; Trauma