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Time of Admission to the PICU and Mortality*

McCrory, Michael C. MD, MS1; Spaeder, Michael C. MD, MS2; Gower, Emily W. PhD3; Nakagawa, Thomas A. MD4,5; Simpson, Sean L. PhD6; Coleman, Mary A. MSN, RN7; Morris, Peter E. MD8

Pediatric Critical Care Medicine: October 2017 - Volume 18 - Issue 10 - p 915-923
doi: 10.1097/PCC.0000000000001268
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Objectives: To evaluate for any association between time of admission to the PICU and mortality.

Design: Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014.

Setting: One hundred and twenty-nine PICUs in the United States.

Patients: Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass.

Interventions: None.

Measurements and Main Results: A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00–09:59 and midday 10:00–13:59 were independently associated with PICU death when compared with the afternoon time period 14:00–17:59 (morning odds ratio, 1.15; 95% CI, 1.04–1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01–1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01–1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14–1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11–1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03–1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons.

Conclusions: Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00–17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer.

1Department of Anesthesiology, Section on Pediatric Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.

2Department of Pediatrics, Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA.

3Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.

4Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.

5Division of Pediatric Critical Care Medicine, Johns Hopkins All Children’s Hospital, St. Petersburg, FL.

6Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.

7Department of Nursing, Carson-Newman University, Jefferson City, TN.

8Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky School of Medicine, Lexington, KY.

*See also p. 986.

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Dr. Nakagawa received funding from UptoDate and Cook Critical Care. Dr. Simpson received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies