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Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards, Jeffrey D. MD, MA, MAS1; Lucas, Adam R. PhD2; Boscardin, W. John PhD3,4; Dudley, R. Adams MD, MBA5,6

doi: 10.1097/CCM.0000000000002439
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Objectives: To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.

Design: Retrospective cohort analysis.

Setting: Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).

Patients: Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.

Interventions: None.

Measurements and Main Results: Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.

Conclusions: Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.

1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY.

2Department of Statistics, University of California, Berkeley, CA.

3Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.

4Department of Medicine, University of California, San Francisco, San Francisco, CA.

5Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA.

6Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.

*See also p. 1409.

This study was performed at University of California, San Francisco and Columbia University Medical Center.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Dr. Edwards is supported by a National Institutes of Health K23 grant (K23 HD 082361). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail:

Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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