Department of Pediatrics, Mayo Clinic Health System, Mankato, Minnesota;
Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
Hosp Pediatr. 2021 Feb;11(2):167-174. doi: 10.1542/hpeds.2020-0192.
Unplanned PICU readmissions within 48 hours of discharge (to home or a different hospital setting) are considered a quality metric of critical care.
We sought to determine identifiable risk factors associated with early unplanned PICU readmissions.
A comprehensive search of Medline, Embase, the Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to July 16, 2018.
Observational studies of early unplanned PICU readmissions (<48 hours) in children (<18 years of age) published in any language were included.
Two reviewers selected and appraised studies independently and abstracted data. A meta-analysis was performed by using the random-effects model.
We included 11 observational studies in which 128 974 children (mean age: 5 years) were evaluated. The presence of complex chronic diseases (odds ratio 2.42; 95% confidence interval 1.06 to 5.55; 79.90%) and moderate to severe disability (odds ratio 2.85; 95% confidence interval 2.40 to 3.40; 11.20%) had the highest odds of early unplanned PICU readmission. Other significant risk factors included an unplanned index admission, initial admission to a general medical ward, spring season, respiratory diagnoses, and longer initial PICU stay. Readmission was less likely after trauma- and surgery-related index admissions, after direct admission from home, or during the summer season. Modifiable risk factors, such as evening or weekend discharge, revealed no statistically significant association. Included studies were retrospective, which limited our ability to account for all potential confounders and establish causality.
Many risk factors for early unplanned PICU readmission are not modifiable, which brings into question the usefulness of this quality measure.
出院后 48 小时内（返回家中或转至其他医院环境）发生的计划外 PICU 再入院被视为重症监护的质量指标。
我们旨在确定与早期计划外 PICU 再入院相关的可识别危险因素。
从每个数据库的创建到 2018 年 7 月 16 日，对 Medline、Embase、Cochrane 系统评价数据库和 Scopus 进行了全面检索。
纳入了以任何语言发表的关于儿童（<18 岁）早期计划外 PICU 再入院（<48 小时）的观察性研究。
两名评审员独立选择和评估研究并提取数据。采用随机效应模型进行荟萃分析。
我们纳入了 11 项观察性研究，其中评估了 128974 名儿童（平均年龄：5 岁）。存在复杂的慢性疾病（优势比 2.42；95%置信区间 1.06 至 5.55； 79.90%）和中度至重度残疾（优势比 2.85；95%置信区间 2.40 至 3.40； 11.20%）的患儿发生早期计划外 PICU 再入院的可能性最高。其他显著的危险因素包括计划外的入院、最初入住普通病房、春季、呼吸诊断以及初始 PICU 住院时间较长。创伤和手术相关的入院后、直接从家中转院后或夏季发生的再入院的可能性较低。可改变的危险因素，如傍晚或周末出院，与统计学上无显著相关性。纳入的研究为回顾性研究，这限制了我们考虑所有潜在混杂因素并确定因果关系的能力。
许多早期计划外 PICU 再入院的危险因素是不可改变的，这使得该质量指标的实用性受到质疑。
