For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
2
views
19
references
 Top references
cited by
0
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      242
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The Association Between Admission Sources and Outcomes at a Pediatric Intensive Care Unit in Al-Ahsa, Saudi Arabia: A Retrospective Cohort Study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objectives

          In this study, we aimed to examine the association between sources of admission (either intra-hospital transfers or ED admissions) in pediatric intensive care units (PICUs) and the discharge rate, mortality rate, and referral over a period of three years. We also sought to identify the independent predictors of discharge and mortality rate in the study population.

          Patients and methods

          This was a retrospective cohort study involving the analysis of 2,547 patients' data collected from the Pediatric Intensive Care Registry of a secondary care community hospital. We included patients admitted to the PICU from January 1, 2016, till December 31, 2018, who were aged 0-14 years with a specific diagnosis, recorded source of admission, and clear outcome. Data were collected, coded, and analyzed using the SPSS Statistics software (IBM, Armonk, NY) and STATA software (StataCorp, College Station, TX).

          Results

          Of the included patients, 1,356 (53.2%) were males, and 1,191 (46.8%) were females. Infants were associated with an increased risk of a long stay in the hospital [relative risk ratio (RRR)=5.34, 95% CI: (1.28, 22.27)] and mortality [RRR=3.56, 95% CI: (1.41, 8.95)] compared to older children. Similarly, neonates were associated with a higher risk of mortality [RRR=2.83, 95% CI: (1.05, 7.65)]. Patients who were admitted through ED were associated with a lower risk of a long-stay [RRR=0.56, 95% CI: (10.36, 0.87)] and mortality [RRR=0.68, 95% CI: (0.49, 0.95)] compared to intra-hospital transfers. Concerning the admission date, all time periods were associated with a lower risk of mortality compared to the period of October-December.

          Conclusion

          Our findings showed that the age of patients, source of admission, and date of admission might be used as independent predictors for determining the outcome of admissions, including discharge and mortality rates. Further studies are required to confirm these findings.

          Related collections

          Most cited references19

          • Record: found
          • Abstract: found
          • Article: not found

          Variations in mortality and length of stay in intensive care units.

          Catherine Draper, Brandie Wagner, W Knaus … (1993)
          To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission. Inception cohort study. Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 large tertiary care hospitals that volunteered for the study. A consecutive sample of 16,622 patients and 17,440 ICU admissions. Data on selected demographic characteristics, comorbidity, and specific physiologic variables were recorded during the first ICU day for an average of 415 admissions at each ICU; hospital discharge status (dead or alive) and length of ICU stay were recorded for individual patients; and the ratio of actual to predicted in-hospital mortality, standardized mortality ratios, and the ratio of actual to predicted length of ICU stay were recorded for individual ICUs. Unadjusted in-hospital mortality rates for the 42 units varied from 6.4% to 40%, and 90% (R2 = 0.90) of this variation was attributable to patient characteristics at admission. The standard mortality ratio varied from 0.67 to 1.25. The mean unadjusted length of ICU stay varied from 3.3 to 7.3 days, and 78% of the variation (R2 = 0.78) was attributed to patient and selected institutional characteristics. The best performing unit had a length of stay ratio of 0.88, whereas the poorest performing unit had a ratio of 1.21. Clinicians can use readily available admission data to adjust for considerable variations in patient severity and type in different ICUs. Such data should permit precise evaluation and comparison of ICU effectiveness and efficiency, which varied substantially in this study, and result in improved methods of risk prediction and evaluation of new medical practices.
          Article 0 comments Cited 64 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center.

            P Mak, Susan K. Wood, Jesse Scruggs … (2007)
            Mortality and length of stay are two outcome variables commonly used as benchmarks in rating the performance of medical centers. Acceptance of transfer patients has been shown to affect both outcomes and the costs of health care. Our objective was to compare observed and predicted lengths of stay, observed and predicted mortality, and resource consumption between patients directly admitted and those transferred to the intensive care unit (ICU) of a large academic medical center. Observational cohort study. Mixed medical/surgical ICU of a university hospital. A total of 4,569 consecutive patients admitted to a tertiary care ICU from April 1, 1997, to March 30, 2000. None. Acute Physiology and Chronic Health Evaluation (APACHE) III score, actual and predicted ICU and hospital lengths of stay, actual and predicted ICU and hospital mortality, and costs per admission. Crude comparison of directly admitted and transfer patients revealed that transfer patients had significantly higher APACHE III scores (mean, 60.5 vs. 49.7, p < .001), ICU mortality (14% vs. 8%, p < .001), and hospital mortality (22% vs. 14%, p < .001). Transfer patients also had longer ICU lengths of stay (mean, 6.0 vs. 3.8 days, p < .001) and hospital lengths of stay (mean, 20 vs. 15.9 days, p < .001). Stratified by disease severity using the APACHE III model, there was no difference in either ICU or hospital mortality between the two populations. However, in the transfer group with the lowest predicted mortality of 0-20%, ICU and hospital lengths of stay were significantly higher. In crude cost analysis, transfer patients' costs were $9,600 higher per ICU admission compared with nontransfer patients (95% confidence interval, $6,000-$13,400). Risk stratification revealed that the higher per-patient cost was entirely confined to the transfer patients with the lowest predicted mortality. Patients transferred to a tertiary care ICU are generally more severely ill and consume more resources. However, they have similar adjusted mortality outcomes when compared with directly admitted patients. The difference in resource consumption is mainly attributable to the group of patients in the lowest predicted risk bracket.
            Article 0 comments Cited 30 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The longer patients are in hospital before Intensive Care admission the higher their mortality.

              P P Tekkis, Vassilis Hadjianastassiou, D Goldhill … (2004)
              To explore the relationship between hospital mortality and time spent by patients on hospital wards before admission to the intensive care unit (ICU). Observational study of prospectively collected data. Participating intensive care units within the North East Thames Regional Database. Patients, 7,190, admitted to ICU from the hospital wards of 24 hospitals. None. Of ICU admissions from the wards, 40.1% were in hospital for more than 3 days and 11.7% for more than 15 days. ICU patients who died in hospital were in-patients longer (p=0.001) before admission (median 3 days; interquartile range 1-9) than those discharged alive (median 2 days; interquartile range 1-5). Hospital mortality increased significantly (p<0.0001) in relation to time on hospital wards before ICU: 47.1% (standardised mortality ratio 1.09) for patients in hospital 0-3 days before ICU admission up to 67.2% (standardised mortality ratio 1.39) for patients on the wards for more than 15 days before ICU. Length of stay before ICU admission was an independent predictor of hospital mortality (odds ratio per day 1.019; 95% confidence interval 1.014-1.024). There were significant differences (p<0.001) in patient age, APACHE II score and predicted mortality in relation to time on wards before ICU admission. Mortality was high among patients admitted from the wards to ICU; many were inpatients for days or weeks before admission. The longer these patients were in hospital before ICU admission, the higher their mortality. Patients with delayed admission differed in some respects compared to those admitted earlier.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 5 November 2020
                Publication date (Electronic, collection): November 2020
                Volume: 12
                Issue: 11
                Electronic Location Identifier: e11356
                Affiliations
                [1 ] Pediatrics, Maternity and Children Hospital Al-Ahsa, Al-Ahsa, SAU
                [2 ] Pediatric Critical Care Medicine, Maternity and Children Hospital Al-Ahsa, Al-Ahsa, SAU
                [3 ] Pediatrics, College of Medicine, King Faisal University, Al-Ahsa, SAU
                [4 ] Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
                [5 ] Pediatrics, King Faisal University, Al-Ahsa, SAU
                [6 ] Medicine, King Faisal University, Al-Ahsa, SAU
                Author notes
                Article
                DOI: 10.7759/cureus.11356
                PMC ID: 7720921
                SO-VID: 67fabe30-833e-48fa-9e60-b92c7224a4b3
                Copyright © Copyright © 2020, AlKadhem et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 5 November 2020
                Categories
                Subject: Emergency Medicine
                Subject: Pediatrics
                Subject: Epidemiology/Public Health

                Keywords: epidemiology,case-specific mortality,pediatric icu,saudi arabia,source of admission
                Data availability:
                Keywords: epidemiology, case-specific mortality, pediatric icu, saudi arabia, source of admission

                Comments

                Comment on this article