Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, MN.
Division of Pediatric Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK.
Pediatr Crit Care Med. 2022 May 1;23(5):e230-e239. doi: 10.1097/PCC.0000000000002920. Epub 2022 Mar 4.
To describe the demographic, clinical, outcome, and cost differences between children with high-frequency PICU admission and those without.
Retrospective, cross-sectional cohort study.
United States.
Children less than or equal to 18 years old admitted to PICUs participating in the Pediatric Health Information System database in 2018.
None.
We assessed survivors of PICU admissions for repeat PICU admissions within a year of their index visit. Children with greater than or equal to 3 PICU admissions within a year were classified as high-frequency PICU utilization (HFPICU). We compared demographic, clinical, outcome, and cost characteristics between children with HFPICU and those with only an index or two admissions per year (nHFPICU). Of 95,465 children who survived an index admission, 5,880 (6.2%) met HFPICU criteria. HFPICU patients were more frequently younger, technology dependent, and publicly insured. HFPICU patients had longer lengths of stay and were more frequently discharged to a rehabilitation facility or with home nursing services. HFPICU patients accounted for 24.8% of annual hospital utilization costs among patients requiring PICU admission. Time to readmission for children with HFPICU was 58% sooner (95% CI, 56-59%) than in those with nHFPICU with two admissions using an accelerated failure time model. Among demographic and clinical factors that were associated with development of HFPICU status calculated from a multivariable analysis, the greatest effect size was for time to first readmission within 82 days.
Children identified as having HFPICU account for 6.2% of children surviving an index ICU admission. They are a high-risk patient population with increased medical resource utilization during index and subsequent ICU admissions. Patients readmitted within 82 days of discharge should be considered at higher risk of HFPICU status. Further research, including validation and exploration of interventions that may be of use in this patient population, are necessary.
描述高频 PICU 入院与非高频 PICU 入院患儿的人口统计学、临床、结局和成本差异。
回顾性、横断面队列研究。
美国。
2018 年在参与儿科健康信息系统数据库的 PICU 接受治疗的年龄不超过 18 岁的患儿。
无。
我们评估了 PICU 出院患儿在其就诊后一年内是否再次入住 PICU。一年内 PICU 入住次数大于等于 3 次的患儿被归类为高频 PICU 使用（HFPICU）。我们比较了 HFPICU 患儿与每年仅入院 1 次或 2 次的患儿（nHFPICU）的人口统计学、临床、结局和成本特征。在 95465 名幸存的 PICU 入院患儿中，有 5880 名（6.2%）符合 HFPICU 标准。HFPICU 患儿更常见于年龄较小、需要使用技术支持、并由公共保险覆盖。HFPICU 患儿的住院时间更长，更常被转到康复机构或接受家庭护理服务。HFPICU 患儿占需要 PICU 入院患儿的年度住院费用的 24.8%。使用加速失效时间模型，HFPICU 患儿的再次入院时间比 nHFPICU 患儿提前 58%（95%CI，56-59%）。在从多变量分析中确定与 HFPICU 状态发展相关的人口统计学和临床因素中，首次出院后 82 天内再次入院的时间的影响最大。
被确定为 HFPICU 的患儿占幸存的首次 ICU 入院患儿的 6.2%。他们是一个高风险的患者群体，在 ICU 入院期间和随后的 ICU 入院期间，医疗资源的使用量增加。出院后 82 天内再次入院的患者应被视为更有可能出现 HFPICU 状态。需要进一步研究，包括对该患者群体可能有用的干预措施进行验证和探索。
