This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tilford, J. M.
Right arrow Articles by Fiser, D. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tilford, J. M.
Right arrow Articles by Fiser, D. H.
Related Collections
Right arrow Office Practice

PEDIATRICS Vol. 106 No. 2 August 2000, pp. 289-294

Volume-Outcome Relationships in Pediatric Intensive Care Units

Received Aug 5, 1999; accepted Nov 29, 1999.

John M. Tilford, Pippa M. Simpson, Jerril W. Green, Shelly Lensing, and Debra H. Fiser

From the Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock, Arkansas.

Context.  Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.

Objectives.  This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.

Design and Setting.  A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group.

Participants.  Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.

Main Outcome Measures.  Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.

Results.  The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio: .95; 95% confidence interval: .91-.99), and reduced length of stay (incident rate ratio: .98; 95% confidence interval: .975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.

Conclusions.  The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.  Key words:  mortality risk, severity of illness, regionalization, quality of care, length of stay.




This article has been cited by other articles:


Home page
 PediatricsHome page
S. B. Yeager, J. D. Horbar, K. M. Greco, J. Duff, R. R. Thiagarajan, and P. C. Laussen
Pretransport and Posttransport Characteristics and Outcomes of Neonates Who Were Admitted to a Cardiac Intensive Care Unit
Pediatrics, September 1, 2006; 118(3): 1070 - 1077.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
F. O. Odetola, J. M. Tilford, and M. M. Davis
Variation in the use of intracranial-pressure monitoring and mortality in critically ill children with meningitis in the United States.
Pediatrics, June 1, 2006; 117(6): 1893 - 1900.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
L. Durairaj, J. C. Torner, E. A. Chrischilles, M. S. Vaughan Sarrazin, J. Yankey, and G. E. Rosenthal
Hospital Volume-Outcome Relationships Among Medical Admissions to ICUs
Chest, September 1, 2005; 128(3): 1682 - 1689.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
Committee on Fetus and Newborn
Levels of Neonatal Care
Pediatrics, November 1, 2004; 114(5): 1341 - 1347.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. A. Lorch, X. Zhang, P. R. Rosenbaum, O. Evan-Shoshan, and J. H. Silber
Equivalent Lengths of Stay of Pediatric Patients Hospitalized in Rural and Nonrural Hospitals
Pediatrics, October 1, 2004; 114(4): e400 - e408.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. Dougherty and L. A. Simpson
Measuring the Quality of Children's Health Care: A Prerequisite to Action
Pediatrics, January 1, 2004; 113(1/S1): 185 - 198.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. H. Clark, J. Cifuentes, J. Bronstein, C. S. Phibbs, S. K. Schmitt, R. H. Phibbs, and W. A. Carlo
Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth
Pediatrics, July 1, 2003; 112(1): 203 - 204.
[Full Text] [PDF]

Home page
 Arch Otolaryngol Head Neck SurgHome page
C. W. Lewis, J. D. Carron, J. A. Perkins, K. C. Y. Sie, and C. Feudtner
Tracheotomy in Pediatric Patients: A National Perspective
Arch Otolaryngol Head Neck Surg, May 1, 2003; 129(5): 523 - 529.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. K. Kanter and M. Egan
Utilization of Pediatric Hospitals in New York State
Pediatrics, May 1, 2003; 111(5): 1068 - 1071.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
A J Henderson, L Garland, S Warne, L Bailey, P Weir, and S Edees
Risk adjusted mortality of critical illness in a defined geographical region
Arch. Dis. Child., March 1, 2002; 86(3): 194 - 199.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. Kuhlthau, T. G. G. Ferris, A. C. Beal, S. L. Gortmaker, and J. M. Perrin
Who Cares for Medicaid-Enrolled Children With Chronic Conditions?
Pediatrics, October 1, 2001; 108(4): 906 - 912.
[Abstract] [Full Text] [PDF]