Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center

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• 作者：Stephen J. Fenton^a ; ^{stephen.fenton@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; ^{sfenton1@me.com" class="auth_mail" title="E-mail the corresponding author} ; Stephen J. Campbell^b ; ^{stephen.campbell@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Austin M. Stevens^a ; ^{austin.stevens@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Chong Zhang^c ; ^{chong.zhang@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Angela P. Presson^c ; ^{angela.presson@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Justin H. Lee^d ; ^{jlee83@uic.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Trauma ; Pediatric ; Intensive care unit
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：51
• 期：10
• 页码：1688-1692
• 全文大小：271 K

文摘

No formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center.

Methods

The trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30 h without surgical intervention, blood transfusion, or ventilator support.

Results

Of 16,209 children, 19% were admitted to the PICU: mean age 7.3 years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6 years, p < 0.001) with a lower median ISS (16 vs. 21, p < 0.001), shorter median PICU LOS (17 vs. 41 h, p < 0.001) and shorter median hospital LOS (51 vs. 121 h, p < 0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury.

Conclusions

A significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.