High-Frequency Utilization of the PICU

Julia A. Heneghan, Manzilat Akande, Denise M. Goodman, Sriram Ramgopal

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To describe the demographic, clinical, outcome, and cost differences between children with high-frequency PICU admission and those without.

DESIGN: Retrospective, cross-sectional cohort study.

SETTING: United States.

PATIENTS: Children less than or equal to 18 years old admitted to PICUs participating in the Pediatric Health Information System database in 2018.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: We assessed survivors of PICU admissions for repeat PICU admissions within a year of their index visit. Children with greater than or equal to 3 PICU admissions within a year were classified as high-frequency PICU utilization (HFPICU). We compared demographic, clinical, outcome, and cost characteristics between children with HFPICU and those with only an index or two admissions per year (nHFPICU). Of 95,465 children who survived an index admission, 5,880 (6.2%) met HFPICU criteria. HFPICU patients were more frequently younger, technology dependent, and publicly insured. HFPICU patients had longer lengths of stay and were more frequently discharged to a rehabilitation facility or with home nursing services. HFPICU patients accounted for 24.8% of annual hospital utilization costs among patients requiring PICU admission. Time to readmission for children with HFPICU was 58% sooner (95% CI, 56-59%) than in those with nHFPICU with two admissions using an accelerated failure time model. Among demographic and clinical factors that were associated with development of HFPICU status calculated from a multivariable analysis, the greatest effect size was for time to first readmission within 82 days.

CONCLUSIONS: Children identified as having HFPICU account for 6.2% of children surviving an index ICU admission. They are a high-risk patient population with increased medical resource utilization during index and subsequent ICU admissions. Patients readmitted within 82 days of discharge should be considered at higher risk of HFPICU status. Further research, including validation and exploration of interventions that may be of use in this patient population, are necessary.

Bibliographical note

Publisher Copyright:
Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Keywords

  • Child
  • Cross-Sectional Studies
  • Hospitalization
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Retrospective Studies
  • Risk Factors
  • United States/epidemiology

PubMed: MeSH publication types

  • Journal Article

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