Intensive care unit admission predicts hospital readmission in pediatric trauma.
BACKGROUND
Hospital readmission in adult trauma is associated with significant morbidity, mortality, and resource utilization. In this study, we examine pediatric intensive care unit (PICU) admission as a risk factor for hospital readmission in pediatric trauma.


MATERIALS AND METHODS
This was a retrospective cohort study of patients aged 1 through 19 y in the Pediatric Health Information System database discharged with a trauma diagnosis. Patient and clinical variables included demographics, payer status, length of stay, chronic comorbid conditions, presence of mechanical ventilation, all-patient refined diagnosis-related group and calculated severity of illness, and discharge disposition. The main outcome variable was hospital readmission within 30 d of discharge. Odds ratios (ORs) were calculated in both univariate and multivariate analyses with corresponding 95% confidence intervals (CIs).


RESULTS
During the 5-year study period, 90,467 patients were admitted with a trauma diagnosis, of which 16,279 (18.0%) were admitted to the PICU. Hospital readmissions occurred in 3.1% of patients. On univariate analysis, patients admitted to the PICU on the first day of hospital admission (direct PICU admission), and those first admitted to the PICU after the day of hospital admission (delayed PICU admission), had 2-3 times the risk of hospital readmission compared with those never admitted to the PICU (4.8% versus 7.2% versus 2.7%, respectively, P < 0.001). On multivariate analysis, controlling for demographic and clinical variables, the adjusted ORs for hospital readmission in patients with direct and delayed PICU admission were 1.34 (95% CI 1.20-1.50) and 1.88 (95% CI 1.50-2.35) versus no PICU admission, respectively.


CONCLUSIONS
PICU admission, either direct or delayed, during hospitalization for trauma care is an independent risk factor for hospital readmission within 30 d of discharge. Further risk stratification may help focus resources on high-risk patients to improve clinical outcomes and reduce readmissions.
['Naseem|Hibbut-Ur-Rauf|HU|', 'Dorman|Robert Michael|RM|', 'Bass|Kathryn D|KD|', 'Rothstein|David H|DH|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D016208:Databases, Factual D005260:Female D006801:Humans D007223:Infant D015278:Intensive Care Units, Pediatric D008297:Male D015999:Multivariate Analysis D016017:Odds Ratio D010343:Patient Admission D010359:Patient Readmission D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome D014481:United States D014947:Wounds and Injuries D055815:Young Adult
Readmission Pediatric Trauma Clinical outcomes PHIS