ABSTRACT 944

Abstract

Background and aims: It is unclear whether patient outcomes vary with PICU volume. Aims: We sought to analyze the relationship between PICU patient volume and severity-adjusted mortality in a large multi-center dataset. Methods: The VPS database (VPS, LLC) was queried for all patients discharged from September 2009 through March 2012 with valid PIM2 and PRISM3 scores. Average PICU volume/quarter (VOL) was calculated as total discharges divided by the number of valid quarters of data per PICU. VOL was then divided by 100 (VOL100) to assess the impact per 100 discharges per quarter. Logistic regression models assessed the relationship of VOL100 and severity-adjusted mortality for the entire sample and subgroups. This study received a waiver as non-human research from CHLA’s IRB. Results: From 113 PICU’s, 194,400 patients were studied, with an overall ICU mortality rate of 2.6%. VOL ranged from 32 to 881; the mean VOL was 269. The odds ratio (OR) for VOL100 was 1.06 (1.04, 1.08) when adjusted with PIM2 and 1.03 (1.00, 1.06) with PRISM3. For the 19,337 patients with a PIM2 ROM > 4%, there was also an increased risk of severity-adjusted mortality as VOL100 increased. In comparison to units with open heart patients (n=99,974), in units without open heart patients (n=94,426), there was no increase in severity-adjusted mortality risk with VOL100. Conclusions: In this preliminary analysis, severity-adjusted mortality appears to increase with PICU volume. This relationship holds for the higher risk patients, but does not appear to be the case in units without open heart patients.