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. The readmission rate varied among PICUs, and acute respiratory, infectious, neurological, and cardiovascular diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions, unscheduled index admission, and transfer to an intermediate unit. Trauma patients had a decreased risk of readmission. 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 and higher mortality. 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. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.