Abstract:
OBJECTIVES:To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. DESIGN:Retrospective cohort analysis. SETTING:Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems. PATIENTS:One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed.There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0-3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002). CONCLUSIONS:Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Edwards JD,Lucas AR,Stone PW,Boscardin WJ,Dudley RAdoi
10.1097/CCM.0b013e31829eb970subject
Has Abstractpub_date
2013-12-01 00:00:00pages
2773-83issue
12eissn
0090-3493issn
1530-0293journal_volume
41pub_type
杂志文章abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To describe the management of patients in an ICU during failure of both primary and backup electrical systems, resulting in nonfunctioning monitors, mechanical ventilators, and other life-support equipment. DESIGN:Case report of power outage and discussion. SETTING:A 45-bed cardiothoracic surgical ICU in a ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199206000-00023
更新日期:1992-06-01 00:00:00
abstract::The current definition of sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by six domains of usefulness (reliability, content, construct and criterion validity, measurement burden, and timeliness). The r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001724
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Catheter-associated infections are common, costly, and potentially lethal. The impact of catheter insertion site on infection risk remains controversial. We aimed to establish whether nontunneled central venous catheters inserted in the subclavian vein are associated with lower risk of catheter-associated inf...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e31823e99cb
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious pr...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.CCM.0000050454.01978.3B
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:Inhaled nitric oxide is being utilized as a selective pulmonary vasodilator in the treatment of persistent pulmonary hypertension of the newborn. However, the effects of inhaled nitric oxide on cerebral hemodynamics and distribution of left ventricular output in newborn subjects have not been studied. This s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199508000-00013
更新日期:1995-08-01 00:00:00
abstract::Eleven patients in hypertensive crisis were treated with iv sodium nitroprusside (SNP). In all cases, rapid clinical improvement was obtained. Nevertheless, 9 patients developed progressive resistance to the hypotensive effect of the drug. For the first 2 h, the mean infusion rate was 1.68 +/- 0.64 micrograms/kg . min...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198205000-00002
更新日期:1982-05-01 00:00:00
abstract:OBJECTIVES:In this study, we evaluated the inflammatory response in patients with severe acute respiratory infection due to the Middle East respiratory syndrome and non-Middle East respiratory syndrome and assessed the presence of distinct inflammatory subphenotypes using latent class analysis. DESIGN:Prospective coho...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004724
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVES:Augmented renal clearance might lead to subtherapeutic plasma levels of drugs with predominant renal clearance. Early identification of augmented renal clearance remains challenging for the ICU physician. We developed and validated our augmented renal clearance predictor, a clinical prediction model for augm...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004667
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:To examine the value of laser bronchoscopy in patients with inoperable carcinoma of the lung who required ventilatory assistance for acute respiratory failure. DESIGN:Retrospective review of the medical records of all patients undergoing laser bronchoscopy. SETTING:The Lahey Clinic Medical Center, a tertiar...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199303000-00016
更新日期:1993-03-01 00:00:00
abstract:OBJECTIVE:To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity. DESIGN:A prospective multicenter observational study conducted in 1-year period. SETTING:F...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001565
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVES:Carbon monoxide poisoning affects 50,000 per year in the United States alone. Mortality is approximately 3%, and up to 40% of survivors suffer from permanent neurocognitive and affective deficits. Hyperbaric oxygen therapy has shown benefit on reducing the long-term neurologic sequelae of carbon monoxide poi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003135
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:To compare the ability of two methods--Acute Physiology and Chronic Health Evaluation (APACHE II) and Mortality Prediction Model (MPM)--to predict hospital outcome for a large group of intensive care patients from Britain and Ireland. DESIGN:Prospective, multicenter, cohort study. SETTING:Twenty-six general...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199409000-00007
更新日期:1994-09-01 00:00:00
abstract:OBJECTIVE:In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of corticosteroid therapy in patients with sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000142983.15421.11
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVES:Radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. The adequacy of the radial artery as a site for blood pressure monitoring in critically ill patients receiving high-dose vasopressors ha...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199810000-00014
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVES:In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quali...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004123
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the action of high-dose epinephrine by measuring simultaneously its vasopressor and norepinephrine releasing effects in humans during cardiac arrest. DESIGN:A prospective study on consecutive patients admitted with cardiac arrest. SETTING:Emergency Department in a large, urban hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199305000-00012
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVE:Toxic free radicals cause dysfunction of respiratory muscles, probably leading to respiratory distress. Exposure to high concentrations of oxygen generates plenty of free radicals. Lidocaine scavenges the reactive molecules. The purposes of the current study were first to examine whether hyperoxia impairs dia...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00048
更新日期:2000-06-01 00:00:00
abstract::It was found that, during 1974, it cost an average of $8842 ($12,909 in 1979) to care for a survivor of severe respiratory distress syndrome (RDS) who required mechanical ventilation in this ICU compared to $2448 ($3574 in 1979) for nonsurvivors. Death in 15 out of the 16 nonsurvivors was accompanied by grade III-IV i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198102000-00005
更新日期:1981-02-01 00:00:00
abstract::The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002172
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:To compare carbon dioxide-induced changes in cerebral oxy- and deoxyhemoglobin, measured by near-infrared spectroscopy, with those changes in jugular venous oxygen saturation in adult patients with acute brain disease. DESIGN:A prospective study. SETTING:The medical and surgical intensive care unit of a uni...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199510000-00019
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVES:There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians' initial ICU admission and intubation decision making processes. Our objective is to describe variation in hospital-based physicians' communication behavior...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318287f0dd
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To compare urea nitrogen removal by continuous hemodiafiltration vs. functional native kidneys in critically ill, septic patients receiving > 2 g of amino acids/kg body weight per day. DESIGN:Prospective, comparative, unblinded study. SETTING:Trauma critical care units of a Level I adult trauma hospital. P...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199403000-00009
更新日期:1994-03-01 00:00:00
abstract:OBJECTIVES:To determine the effects of sustained, 3-day endotoxin infusion on early steps of the insulin-signaling pathway in rat liver and skeletal muscle in vivo; to examine insulin signaling in well-established acute endotoxin models of insulin resistance. DESIGN:Prospective, controlled animal study. SETTING:Unive...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00032
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to evaluate safety (primary) and clinical efficacy (secondary) of the humanized monoclonal anti-L-selectin antibody aselizumab in severely injured patients. DESIGN:Prospective phase II, parallel group, double-blind, randomized, placebo-controlled clinical trial. SETTING:Fou...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000142396.59236.f3
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVES:A 2400-mOsm/L hypertonic solution (isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199607000-00027
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:Anecdotal reports suggest that propofol (Diprivan) may stimulate mucus hypersecretion in patients without pulmonary disease. The purpose of this study was to evaluate the effect of methohexital or propofol anesthesia on the physical and transport properties of airway mucus in spontaneously breathing dogs. DE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200105000-00035
更新日期:2001-05-01 00:00:00
abstract:PURPOSES:To discuss the theoretical relationship of mean alveolar pressure to its most easily measured analog, the mean airway pressure, and to describe the key determinants, measurement considerations, and clinical implications of this index. DATA SOURCES:Relevant articles from the medical and physiologic literature,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::Foreign-body aspiration in adults is usually associated with asphyxiation after aspiration of food particles. The present report documents a case of foreign-body aspiration that resulted from poor tracheostomy care in an alcoholic patient, and caused fulminant pneumonitis. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198408000-00020
更新日期:1984-08-01 00:00:00
abstract::Hypersensitivity reactions are defined as immunologically based adverse reactions to chemicals or medicinal agents. These reactions are common in the intensive care unit and can present as a simple, mildly symptomatic rash or as life-threatening anaphylactic reactions. Hypersensitivity reactions have traditionally bee...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181de0c99
更新日期:2010-06-01 00:00:00