Edwards Jeffrey D, Lucas Adam R, Boscardin W John, Dudley R Adams
1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY.2Department of Statistics, University of California, Berkeley, CA.3Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.4Department of Medicine, University of California, San Francisco, San Francisco, CA.5Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA.6Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
Crit Care Med. 2017 Aug;45(8):1276-1284. doi: 10.1097/CCM.0000000000002439.
To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.
Retrospective cohort analysis.
Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).
Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.
None.
Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.
Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
确定1年内儿科重症监护病房（PICU）非计划再入院的发生率，并检查与再次入院相关的危险因素。
回顾性队列分析。
参与虚拟儿科系统有限责任公司（VPS，LLC，加利福尼亚州洛杉矶）的76家北美PICU。
2009年至2010年间出院的93379名PICU患者。
无。
对首次入院和非计划再入院进行特征描述并比较其结局。进行事件发生时间分析以检查与1年内再入院相关的因素。11%（10233例）患者在1年内有15625次非计划再入院至同一PICU；3.4%的患者有两次或更多次再入院。与首次入院相比，再入院患者的PICU死亡率显著更高，PICU住院时间更长（4.0%对2.5%以及2.5天对1.6天；所有p<0.001）。所有再入院患者的再入院中位时间为30天，同一住院期间再入院的中位时间为3.5天，不同住院期间再入院的中位时间为66天。患有更复杂慢性病与更早再入院相关（一种复杂慢性病的调整风险比为2.9；两种复杂慢性病的风险比为4.8；三种或更多复杂慢性病的风险比为9.6；与无复杂慢性病相比，所有p<0.001）。大多数特定的复杂慢性病赋予了更高的再入院风险，并且有些慢性病的风险比其他慢性病高得多。
相当一部分PICU患者发生了非计划再入院。患有复杂慢性病和特定疾病的患者再入院风险要高得多。
