Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e906-e911 (doi:10.1542/peds.2007-2089)
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ARTICLE

Comparison of Critically Ill and Injured Children Transferred From Referring Hospitals Versus In-House Admissions

Christopher J. Gregory, MDa, Farid Nasrollahzadeh, MDa, Madan Dharmar, MBBSa, Kourosh Parsapour, MDa and James P. Marcin, MD, MPHb

a Department of Pediatrics, University of California Davis Children's Hospital
b University of California Davis Center for Health Services Research in Primary Care, University of California, Davis, California

OBJECTIVE. The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital.

METHODS. We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward.

RESULTS. Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in-house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days).

CONCLUSIONS. On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children.

Key Words: hospitalized children • patient transfer • severity of illness • efficiency • outcome assessment • critical illness

Abbreviations: PRISM III—Pediatric Risk of Mortality III • PICUE—Pediatric Intensive Care Unit Evaluation • ED—emergency department • LOS—length of stay

Accepted Sep 21, 2007.