After-hours admissions are not associated with increased risk-adjusted mortality in pediatric intensive care

Abstract

Objective: To examine the influence of time of admission on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (ICU) without 24-h per day in-house intensivist coverage.

Design: Data analyzed came from a comprehensive, prospectively collected ICU database.

Setting: A 12-bed pediatric ICU located in a university-affiliated tertiary referral children's hospital.

Patients: Subjects consisted of 4,456 consecutive nonelective patients admitted over a 10-year period (1997-2006).

Interventions: None.

Measurements and results: Patients were categorized according to time of admission to the ICU as either in-hours (0800-1800 Monday-Friday and 0800-1200 on weekends), when an intensivist is present in the ICU, or after-hours (all other times), when intensivists attend only on an as-needed basis. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the Paediatric Index of Mortality (PIM). Patients admitted after hours had a lower risk-adjusted mortality than those admitted during normal working hours, with an odds ratio for death of 0.712 (95% confidence interval 0.518-0.980, p = 0.037). Length of stay was also significantly shorter for patients admitted after hours (44.05h vs. 50.0h, p = 0.001).

Conclusions: A lack of in-house intensivist presence is not associated with any increase in mortality or length of stay for patients admitted to our pediatric ICU; on the contrary, after-hours admission in this cohort was associated with a decreased risk-adjusted mortality and a shorter length of stay.