Brisca Giacomo, Pepino Carlotta, Mariani Marcello, Tardini Giacomo, Romanengo Marta, Giacheri Emanuele, Mallamaci Marisa, Buffoni Isabella, Carrato Valentina, Strati Marina Francesca, Santaniello Stefania, Taravella Rossana, Puzone Laura, Rossoni Lisa, Di Filippo Michela, Pirlo Daniela, Moscatelli Andrea
Neonatal and Pediatric Intensive Care, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
Emergency Room and Pediatric Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
J Clin Med. 2025 Sep 10;14(18):6398. doi: 10.3390/jcm14186398.
Pediatric Intermediate Care Units (PIMCUs) provide enhanced monitoring and support for children who require more care than standard wards but do not meet full Pediatric Intensive Care Unit (PICU) criteria. Despite their growing role, evidence on how to stratify risk and predict clinical trajectories within this specific population remains scarce. This study aimed to identify admission factors associated with (1) early unplanned transfer to the PICU within 48 h and (2) prolonged length of stay (LOS) in the PIMCU of a tertiary Italian pediatric hospital. We conducted a retrospective observational study including 893 children admitted to the PIMCU at IRCCS Gaslini Children's Hospital (Genoa, Italy) between January 2022 and June 2023. Demographic, clinical, laboratory, and outcome data were collected. Multivariable logistic regression and negative binomial models were used to assess predictors of early PICU transfer and prolonged LOS, respectively. Early PICU transfer occurred in 2.8% of cases. Tachypnea (OR = 2.80; = 0.018) and nasogastric tube (OR = 3.72; = 0.014) at admission were independently associated with PICU transfer within 48 h. Prolonged LOS was significantly associated with the need for respiratory support and the presence of medical devices, including nasogastric tubes, central venous lines, and thoracic/abdominal drains. Specific clinical markers and device use at admission can help identify patients at higher risk of deterioration or extended PIMCU stay, supporting more accurate triage, early intervention, and resource optimization in pediatric intermediate care settings.
儿科中级护理病房（PIMCUs）为那些需要比标准病房更多护理但不符合儿科重症监护病房（PICU）全部标准的儿童提供强化监测和支持。尽管其作用日益重要，但关于如何在这一特定人群中进行风险分层和预测临床病程的证据仍然匮乏。本研究旨在确定与以下情况相关的入院因素：（1）48小时内早期非计划转入PICU；（2）意大利一家三级儿科医院的PIMCU住院时间延长（LOS）。我们进行了一项回顾性观察研究，纳入了2022年1月至2023年6月期间在IRCCS加斯利尼儿童医院（意大利热那亚）PIMCU住院的893名儿童。收集了人口统计学、临床、实验室和结局数据。分别使用多变量逻辑回归和负二项模型评估早期PICU转入和住院时间延长的预测因素。2.8%的病例发生了早期PICU转入。入院时呼吸急促（OR = 2.80；P = 0.018）和鼻胃管（OR = 3.72；P = 0.014）与48小时内转入PICU独立相关。住院时间延长与呼吸支持需求以及包括鼻胃管、中心静脉导管和胸/腹腔引流管在内的医疗设备的存在显著相关。入院时的特定临床指标和设备使用情况有助于识别病情恶化或PIMCU住院时间延长风险较高的患者，支持儿科中级护理环境中更准确的分诊、早期干预和资源优化。
