Long Stay and Frequent Readmission in the Pediatric Intensive Care in The Netherlands; 15-Year Time Trends.

UNLABELLED

To describe time trends and the burden of long-stay patients (LSP) and frequent-readmission patients (FRP) in the PICUs in The Netherlands.

DESIGN

Retrospective analysis of data from the nationwide Pediatric Intensive Care Evaluation registry including all PICU admissions in The Netherlands.

SETTING

All PICUs in The Netherlands.

PATIENTS

All PICU patients less than 18 years old admitted between 2003 and 2017. Two groups of patients were identified: LSP (admitted ≥30 d) and FRP (≥3 readmissions within the first year after their first admission).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A total of 47,424 children were admitted on 59,759 occasions. LSP (3.3% of total cohort) and FRP (2.1%) accounted for 37.5% and 14.5% of cumulative admission days, respectively. Patients fulfilling both LSP and FRP criteria (0.6%) accounted for 9.9% of cumulative admission days. No significant time trends were observed between 2003 and 2017 for the number of LSP and FRP, nor for accounted cumulative admission days. Age and disease severity-adjusted mortality was significantly higher for LSP (odds ratio [OR], 2.16; 95% CI, 1.66-2.82; < 0.001) and FRP OR 1.40 (95% CI, 0.97-2.01; = 0.069) compared with the general PICU population. Overall PICU mortality decreased significantly between 2003 (6.5%) and 2017 (3.7%; = 0.004), but remained constant over time for both LSP (17.2%) and FRP (6.3%).

CONCLUSIONS

The proportion of LSP and FRP and their burden on PICU capacity are considerable and remained constant between 2003 and 2017. Whereas age and disease severity-adjusted mortality decreased in the general PICU population, it did not change in LSP and FRP.