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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31829eb970
Pediatric Critical Care

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Edwards, Jeffrey D. MD, MA, MAS1; Lucas, Adam R. PhD2; Stone, Patricia W. PhD, RN3,4; Boscardin, W. John PhD5,6; Dudley, R. Adams MD, MBA7,8

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Abstract

Objectives: To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions.

Design: Retrospective cohort analysis.

Setting: Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems.

Patients: One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011.

Interventions: None.

Measurements and Main Results: Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed.There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0–3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002).

Conclusions: Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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