Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Pizzuto, Matthew F.
  • Sutton, Ashley G.
    • Affiliation: School of Medicine, Department of Pediatrics
  • Schroeder, Katherine S.
    • Affiliation: School of Medicine, Department of Pediatrics
  • Bravo, Mercedes A.
    • Other Affiliation: Duke University
  • Li, Lang
    • Affiliation: School of Medicine, Department of Pediatrics
  • Kihlstrom, Margaret J.
    • Affiliation: School of Medicine, Department of Pediatrics
Abstract
  • Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≤18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P < .01) and require a home ventilator at discharge (24% vs 1%, P < .01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P < .01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P < .01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P < .05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P = .88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded.
Date of publication
Keyword
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • SAGE Publications
License
  • Attribution-NonCommercial 4.0 International
Journal title
  • Journal of Intensive Care Medicine
Journal volume
  • 38
Journal issue
  • 8
Page start
  • 737
Page end
  • 742
Funder
  • School of Medicine, University of North Carolina at Chapel Hill
ISSN
  • 0885-0666
  • 1525-1489
Copyright date
  • 2023
Publisher
  • SAGE Publications

Relations

Parents:

This work has no parents.

In Collection:

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 10.1177_08850666231162530.pdf 2023-08-24 Public Download