Date

8-2014

Document Type

Thesis

Degree Name

M.P.H.

Department

Department of Public Health & Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Objectives:

We sought to evaluate pediatric Emergency Department (ED) patients who fail ward disposition and identify patient-level ED risk factors that might predict deterioration following ward and subsequent PICU admissions.

Methods:

Pediatric patient charts between May 1, 2008 and December 31, 2012 were retrospectively analyzed. The primary outcome was unplanned ICU admission defined as patient transferred to ICU after staying in the inpatient general ward unit for less than 24 hours. Analysis focused on patient-level data including vital signs. The association between patient characteristics and unplanned ICU admissions were assessed using a multivariable logistic analysis regression while controlling for other confounders.

Results:

Out of 6,361 patients admitted to the ward from the ED, 80 failed ward admission and were admitted to the ICU within 24 hours of ward admission. Independent predictors of unplanned ICU admission included average length of stay in the ED (OR = 1.45, 95% CI= 0.92 to 2.29), resident specialty (OR = 2.03, 95% CI = 1.15 to 3.56), abnormal pulse oximetry (spO2) < 90% (OR = 2.95, 95% CI = 0.56 to 10.15). Lower triage acuity was associated with a lower likelihood of unplanned ICU admission (OR =0.50, 95% CI = 0.32 to 0.78). We did not find significant interactions the predictors of unplanned ICU admission.

Conclusion:

We found that

Identifier

doi:10.6083/M4F18XGP

School

School of Medicine

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