Online Clinical Investigations

A Retrospective Case-Control Study to Identify Predictors of Unplanned Admission to Pediatric Intensive Care Within 24 Hours of Hospitalization*

Krmpotic, Kristina MD, MSc^1,2; Lobos, Anna-Theresa MD¹; Chan, Jason MSc³; Toppozini, Christina BScN, MPH⁴; McGahern, Candice BA³; Momoli, Franco PhD^3,5,6; Plint, Amy C. MD, MSc^1,7

Author Information

¹Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.

²Departments of Critical Care and Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.

³Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.

⁴Division of Nursing Practice and Education, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada.

⁵Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

⁶School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

⁷Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.

*See also p. 685.

Supported, in part, by an operating grant from the Children’s Hospital of Eastern Ontario Research Institute.

Dr. Krmpotic disclosed that this study was funded by an operating grant from the Children’s Hospital of Eastern Ontario Research Institute. Dr. Toppozini received funding from acting as a Children’s Hospital of Eastern Ontario Research Institute research assistant (aided in design of data collection tool, data collection and verification, interpretation, and writing/revising article). Dr. Plint’s institution received funding from Children’s Hospital of Eastern Ontario Research Institute, and she disclosed that she is supported in part by a University of Ottawa Tier II Clinical Research Chair award. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Current affiliation for Dr. Krmpotic: Pediatric Critical Care, IWK Health Centre, 5850/5980 University Ave, Halifax, NS, B3K6R8, Canada.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 20(7):p e293-e300, July 2019. | DOI: 10.1097/PCC.0000000000001977

Abstract

Objectives:

To identify the clinical findings available at the time of hospitalization from the emergency department that are associated with deterioration within 24 hours.

Design:

A retrospective case-control study.

Setting:

A pediatric hospital in Ottawa, ON, Canada.

Patients:

Children less than 18 years old who were hospitalized via the emergency department between January 1, 2008, and December 31, 2012. Cases (n = 98) had an unplanned admission to the PICU or unexpected death on the hospital ward within 24 hours of hospitalization and controls (n = 196) did not.

Interventions:

None.

Main Results:

Ninety-eight children (53% boys; mean age 63.2 mo) required early unplanned admission to the PICU. Multivariable conditional logistic regression resulted in a model with five predictors reaching statistical significance: higher triage acuity score (odds ratio, 4.1; 95% CI, 1.7–10.2), tachypnea in the emergency department (odds ratio, 4.6; 95% CI, 1.8–11.8), tachycardia in the emergency department (odds ratio, 2.6; 95% CI, 1.1–6.5), PICU consultation in the emergency department (odds ratio, 8.0; 95% CI, 1.1–57.7), and admission to a ward not typical for age and/or diagnosis (odds ratio, 4.5; 95% CI, 1.7–11.6).

Conclusions:

We have identified risk factors that should be included as potential predictor variables in future large, prospective studies to derive and validate a weighted scoring system to identify hospitalized children at high risk of early clinical deterioration.

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A Retrospective Case-Control Study to Identify Predictors of Unplanned Admission to Pediatric Intensive Care Within 24 Hours of Hospitalization*