title: Readmission and Late Mortality After Critical Illness in Childhood.
abstract: OBJECTIVE
  Little is known about the ongoing mortality risk and healthcare utilization among U.S. children after discharge from a hospitalization involving ICU care. We sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  This study was performed using administrative claims data from 2006-2013 obtained from the Truven Health Analytics MarketScan Database.
  
  
  METHODS
  We included all children in the dataset admitted to a U.S. ICU less than or equal to 18 years old.
  
  
  METHODS
  The primary outcome was nonelective readmission in the year following discharge. Risk of rehospitalization was determined using a Cox proportional hazards model.
  
  
  RESULTS
  We identified 109,130 children with at least one ICU admission in the dataset. Over three quarters of the index ICU admissions (78.6%) had an ICU length of stay less than or equal to 3 days, and the overall index hospitalization mortality rate was 1.4%. In multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. By the end of the 1-year observation period, 36.0% of children with an index ICU length of stay greater than or equal to 14 days had been readmitted, compared with only 13.9% of children who had an index ICU length of stay equals to 1 day. Mortality in the year after ICU discharge was low overall (106 deaths per 10,000 person-years of observation) but was high among children with an initial index ICU admission length of stay greater than or equal to 14 days (599 deaths per 10,000 person-years).
  
  
  CONCLUSIONS
  Readmission after ICU care is common. Further research is needed to investigate the potentially modifiable factors affecting likelihood of readmissions after discharge from the ICU. Although late mortality was relatively uncommon overall, it was 10-fold higher in the year after ICU discharge than in the general U.S. pediatric population.
authors.affiliation: 1Department of Pediatric Intensive Care, Washington University in St. Louis, St. Louis, MO. 2Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, MO. 3Pediatric Critical Care, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. 4Department of Pediatrics, University of Arizona, Tucson, AZ. 5San Antonio Military Medical Center, United States Air Force, San Antonio, TX. 6Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hartman
authors.forename: Mohammed J
authors.initials: MJ
authors.lastname: Saeed
authors.forename: Tellen
authors.initials: T
authors.lastname: Bennett
authors.forename: Katri
authors.initials: K
authors.lastname: Typpo
authors.forename: Renee
authors.initials: R
authors.lastname: Matos
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology