Williams Vijai, Jaiswal Nishant, Chauhan Anil, Pradhan Pranita, Jayashree Muralidharan, Singh Meenu
Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India.
Department of Telemedicine, Postgraduate Institute of Medical Research and Education, Chandigarh, India.
J Pediatr Intensive Care. 2020 Mar;9(1):1-11. doi: 10.1055/s-0039-3399581. Epub 2019 Nov 18.
The aim of this study was to determine the association between the time of admission (day, night, and/or weekends) and mortality among critically ill children admitted to a pediatric intensive care unit (PICU). Electronic databases that were searched include PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Ovid, and Cochrane Library since inception till June 15, 2018. The article included observational studies reporting inhospital mortality and the time of admission to PICU limited to patients aged younger than 18 years. Meta-analysis was performed by a frequentist approach with both fixed and random effect models. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the quality of evidence. Ten studies met our inclusion criteria. Five studies comparing weekday with weekend admissions showed better odds of survival on weekdays (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.60-0.99). Pooled data of four studies showed that odds of mortality were similar between day and night admissions (OR: 0.93; 95% CI: 0.77-1.13). Similarly, three studies comparing admission during off-hours versus regular hours did not show better odds of survival during regular hours (OR: 0.77; 95% CI: 0.57-1.05). Heterogeneity was significant due to variable sample sizes and time period. Inconsistency in adjusting for confounders across the included studies precluded us from analyzing the adjusted risk of mortality. Weekday admissions to PICU were associated with lesser odds of mortality. No significant differences in the odds of mortality were found between admissions during day versus night or between admission during regular hours and that during off-hours. However, the evidence is of low quality and requires larger prospective studies.
本研究旨在确定儿科重症监护病房（PICU）收治的危重症儿童的入院时间（白天、夜间和/或周末）与死亡率之间的关联。检索的电子数据库包括自创建至2018年6月15日的PubMed、Embase、科学网、护理及相关健康文献累积索引（CINAHL）、Ovid和Cochrane图书馆。纳入的文章为报告住院死亡率及PICU入院时间且研究对象限于18岁以下患者的观察性研究。采用频率学派方法，运用固定效应模型和随机效应模型进行荟萃分析。采用推荐分级的评估、制定与评价（GRADE）方法评估证据质量。十项研究符合我们的纳入标准。五项比较工作日与周末入院情况的研究显示，工作日的生存几率更高（优势比[OR]：0.77；95%置信区间[CI]：0.60 - 0.99）。四项研究的汇总数据显示，白天和夜间入院的死亡率几率相似（OR：0.93；95% CI：0.77 - 1.13）。同样地，三项比较非工作时间与正常时间入院情况的研究未显示正常时间入院有更高的生存几率（OR：0.77；95% CI：0.57 - 1.05）。由于样本量和时间段不同，异质性显著。纳入研究在调整混杂因素方面存在不一致，这使我们无法分析调整后的死亡风险。PICU的工作日入院与较低的死亡几率相关。白天与夜间入院之间或正常时间与非工作时间入院之间的死亡几率未发现显著差异。然而，证据质量较低，需要开展更大规模的前瞻性研究。
