Intensive care unit admission predicts hospital readmission in pediatric trauma

Abstract

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.

Keywords: Clinical outcomes; PHIS; Pediatric; Readmission; Trauma.