McCrory Michael C, Spaeder Michael C, Gower Emily W, Nakagawa Thomas A, Simpson Sean L, Coleman Mary A, Morris Peter E
1Department of Anesthesiology, Section on Pediatric Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. 2Department of Pediatrics, Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA. 3Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. 4Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD. 5Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL. 6Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC. 7Department of Nursing, Carson-Newman University, Jefferson City, TN. 8Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky School of Medicine, Lexington, KY.
Pediatr Crit Care Med. 2017 Oct;18(10):915-923. doi: 10.1097/PCC.0000000000001268.
To evaluate for any association between time of admission to the PICU and mortality.
Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014.
One hundred and twenty-nine PICUs in the United States.
Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass.
None.
A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00-09:59 and midday 10:00-13:59 were independently associated with PICU death when compared with the afternoon time period 14:00-17:59 (morning odds ratio, 1.15; 95% CI, 1.04-1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01-1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01-1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14-1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11-1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03-1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons.
Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00-17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer.
评估儿科重症监护病房（PICU）的入院时间与死亡率之间是否存在关联。
对2009年至2014年虚拟儿科系统（VPS，LLC，加利福尼亚州洛杉矶）数据库中PICU的入院情况进行回顾性队列研究。
美国129个PICU。
入住参与研究的PICU的18岁以下患者；排除心脏搭桥术后患者。
无。
共纳入391,779例入院病例，观察到的PICU死亡率为2.31%。总体死亡率在07:00至07:59入院的患者中最高（3.32%），在14:00至14:59入院的患者中最低（1.99%）。工作日死亡率最高的是08:00至08:59入院的患者（3.30%），周末死亡率最高的是09:00至09:59入院的患者（4.66%）。在多变量回归分析中，与下午时间段14:00至17:59相比，上午06:00至09:59和中午10:00至13:59入院与PICU死亡独立相关（上午优势比为1.15；95%置信区间为1.04 - 1.26；p = 0.006，中午优势比为1.09；95%置信区间为1.01 - 1.18；p = 0.03）。当分为工作日和周末入院时，仅工作日上午入院与死亡几率增加相关（优势比为1.13；95%置信区间为1.01 - 1.27；p = 0.03），而周末上午（优势比为1.33；95%置信区间为1.14 - 1.55；p = 0.004）、中午（优势比为1.27；95%置信区间为1.11 - 1.45；p = 0.0006）和下午（优势比为1.17；95%置信区间为1.03 - 1.32；p = 0.01）入院与工作日下午相比，死亡风险增加。
与工作日下午入院相比，工作日上午06:00至09:59入院以及周末全天（06:00至17:59）入院与PICU死亡独立相关。值得进一步研究的潜在影响因素包括护理交接、查房、与资源可用性相关的延误或转运前未被识别的患者病情恶化。
