Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center

Abstract

BackgroundNo formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center. MethodsThe trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30h without surgical intervention, blood transfusion, or ventilator support. ResultsOf 16,209 children, 19% were admitted to the PICU: mean age 7.3years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6years, p<0.001) with a lower median ISS (16 vs. 21, p<0.001), shorter median PICU LOS (17 vs. 41h, p<0.001) and shorter median hospital LOS (51 vs. 121h, p<0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury. ConclusionsA significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.