Raphael Jean L, Richardson Troy, Hall Matt, Oyeku Suzette O, Bundy David G, Kalpatthi Ram V, Shah Samir S, Ellison Angela M
Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Children's Hospital Association, Overland Park, KS.
J Pediatr. 2015 Dec;167(6):1306-13. doi: 10.1016/j.jpeds.2015.09.007. Epub 2015 Oct 23.
To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD).
We conducted a retrospective cohort study of 83,477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS.
Of 83,477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS.
Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.
评估镰状细胞病（SCD）住院患儿的医院规模与重症监护病房（ICU）转入之间的关系。
我们使用儿科健康信息系统数据库，对儿童医院在2009年至2012年期间83477例与SCD相关的住院病例进行了一项回顾性队列研究。将医院层面的全因病例数和SCD特定病例数进行二分法划分（低与高）。结局指标为院内ICU转入（主要指标）和总住院时长（LOS，次要指标）。多变量逻辑/线性回归分析评估了医院规模与ICU转入及住院时长之间的关联。
在83477例符合条件的住院病例中，1741例（2.1%）涉及1432名不同儿童出现了ICU转入情况。SCD特定病例数高（比值比[OR]0.77，95%置信区间[CI]0.64 - 0.91）与ICU转入几率较低相关，而全因医院病例数高则不然（OR 0.87，95% CI 0.73 - 1.04）。发现全因病例数和SCD特定病例数之间存在统计学显著的交互作用。当根据全因病例数进行分层分析时，SCD特定病例数高与全因病例数低时的ICU转入几率较低相关（OR 0.46，95% CI 0.38 - 0.55）。全因病例数高（OR 0.94，95% CI 0.92 - 0.97）和SCD特定病例数高（OR 0.86，95% CI 0.84 - 0.88）均与住院时长较短相关。
儿童医院在将SCD患儿转入ICU方面，因医院规模不同而存在很大差异。了解不同机构所采用的做法可能有助于解释在照顾SCD患儿的医院中ICU转入情况的变异性。
