Czolgosz Thomas, Cashen Katherine, Farooqi Ahmad, Kannikeswaran Nirupama
From the Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan.
Division of Critical Care Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan.
Pediatr Emerg Care. 2019 Aug;35(8):568-574. doi: 10.1097/PEC.0000000000001887.
Few studies have evaluated impact of emergency department (ED) management on delayed transfers to the pediatric intensive care unit (PICU). Our study objectives were to describe patient characteristics of PICU transfers less than or equal to 12 hours of admission and determine the reason for transfer.
We conducted a retrospective chart review of patients transferred to PICU less than or equal to 12 hours of admission. We extracted patient demographics, emergency severity index category, ED, floor and PICU length of stay (LOS), and PICU "significant" interventions. Charts were reviewed independently by the study principal investigator and a PICU attending who classified transfers as secondary to progression of disease or error in ED management. Furthermore, errors were classified as diagnostic, management, or disposition errors.
A total of 164 patients met inclusion criteria. Most were male (86/164, 52.4%), with emergency severity index category 2 (116/164, 70.7%) and respiratory diagnosis (98/164, 59.8%). Most transfers (136/164, 82.9%) resulted from progression of illness. No significant interventions were performed in 48.8% (80/164) of patients. Of 164 transfers, 28 (17.1%) resulted from ED error, and half of these were management errors. Compared with disease progression, the ED error group had a significantly shorter median floor LOS {3.45 [interquartile range (IQR): 2.15, 7.56] vs 6.58 (IQR: 3.70, 9.20); P = 0.005}, more PICU interventions [1.5 (IQR: 0, 4) vs 0 (IQR: 0, 2); P = 0.006], and longer PICU LOS [2.50 (IQR: 1.09, 4.25) vs 1.36 (IQR: 0.80, 2.50); P = 0.013].
Most PICU transfers less than or equal to 12 hours after admission result from illness progression. Half of these do not require significant interventions. The PICU transfers after ED management error had significantly shorter floor LOS, longer PICU LOS, and more interventions.
很少有研究评估急诊科（ED）管理对延迟转入儿科重症监护病房（PICU）的影响。我们的研究目的是描述入院后12小时内转入PICU患者的特征，并确定转入原因。
我们对入院后12小时内转入PICU的患者进行了回顾性病历审查。我们提取了患者人口统计学信息、急诊严重程度指数类别、急诊科、病房和PICU住院时间（LOS），以及PICU的“重大”干预措施。研究主要研究者和一名PICU主治医生独立审查病历，他们将转入原因分类为疾病进展或ED管理失误。此外，失误被分类为诊断、管理或处置失误。
共有164名患者符合纳入标准。大多数为男性（86/164，52.4%），急诊严重程度指数类别为2（116/164，70.7%），诊断为呼吸系统疾病（98/164，59.8%）。大多数转入（136/164，82.9%）是由疾病进展导致的。48.8%（80/164）的患者未进行重大干预。在164次转入中，28次（17.1%）是由ED失误导致的，其中一半是管理失误。与疾病进展相比，ED失误组的病房中位住院时间明显更短{3.45[四分位间距（IQR）：2.15，7.56]对6.58（IQR：3.70，9.20）；P = 0.005}，PICU干预更多[1.5（IQR：0，4）对0（IQR：0，2）；P = 0.006]，PICU住院时间更长[2.50（IQR：1.09，4.25）对1.36（IQR：0.80，2.50）；P = 0.013]。
大多数入院后12小时内转入PICU是由疾病进展导致的。其中一半不需要重大干预。ED管理失误后转入PICU的患者病房住院时间明显更短，PICU住院时间更长，干预更多。
