Division of Critical Care, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
J Crit Care. 2013 Oct;28(5):625-33. doi: 10.1016/j.jcrc.2013.02.008. Epub 2013 Apr 16.
The purpose of the study was to compare patients readmitted to the pediatric intensive care unit (PICU) unexpectedly within 48 hours (early), more than 48 hours from transfer (late), or not readmitted during the same hospitalization.
A retrospective study (2007-2009) was performed at a tertiary care pediatric academic hospital. Readmitted at-risk patients were grouped by timing of readmission, and a sample of nonreadmitted patients was randomly selected. Early readmissions were compared to late readmissions and to nonreadmissions.
Of 3805 eligible patients, 3.9% had an unplanned PICU readmission with almost half occurring within 48 hours. Median times to readmission were 21.5 hours (early) and 7 days (late). Compared with late readmissions, early readmissions were more often admitted from and transferred to a surgical service, transferred on a weekend, and readmitted with the same primary diagnosis. Compared with nonreadmitted patients, independent risk factors for early readmission were admission source and respiratory support at PICU transfer. Readmitted patients had longer total PICU and hospital lengths of stay than nonreadmitted patients. Late readmissions had a higher mortality than early readmissions.
Patients requiring an unplanned PICU readmission had worse outcomes than those without a readmission. Future studies should focus on identifying modifiable risk factors for targeted interventions.
本研究旨在比较在住院期间 48 小时内（早期）、超过 48 小时（晚期）或未再次入院的儿科重症监护病房（PICU）意外再次入院的患者。
对一家三级儿科学术医院的回顾性研究（2007-2009 年）进行了回顾性研究。根据再入院时间将有风险的再入院患者分组，并随机选择未再入院的患者作为样本。将早期再入院与晚期再入院和未再入院进行比较。
在 3805 名符合条件的患者中，3.9%的患者出现计划外 PICU 再入院，其中近一半发生在 48 小时内。再入院的中位时间为 21.5 小时（早期）和 7 天（晚期）。与晚期再入院相比，早期再入院更常从外科病房入院和转科，周末转科，且以相同的主要诊断再次入院。与未再入院的患者相比，早期再入院的独立危险因素是 PICU 转科时的入院来源和呼吸支持。与未再入院的患者相比，再入院患者的 PICU 总住院时间和住院总时间更长。晚期再入院的死亡率高于早期再入院。
需要计划外 PICU 再入院的患者比未再入院的患者预后更差。未来的研究应重点确定可改变的危险因素，以便进行有针对性的干预。
