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Preventable Pediatric Intensive Care Unit (PICU) Admissions Over a 15-Year Period at a Level 1 Pediatric Trauma Center
Stephen J. Fenton, MD, Stephen Campbell, Justin H. Lee, Austin M. Stevens, Chong Zhang and Angela P. Presson, University of Utah School of Medicine, Salt Lake City UT

Abstract: Introduction: No criteria exist to determine the need for admission of injured children to the pediatric intensive care unit (PICU). Our objective was to identify factors associated with trauma patient admissions to the PICU at a level-I pediatric trauma center. Methods: The trauma registry was analyzed for trauma team admissions to the PICU between 1998-2013. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30-hours of admission without surgical intervention, blood transfusion, or ventilator support. Results: Of the 16,209 children evaluated, 3,042 (19%) were admitted to the PICU. The mean age was 7.3 years, 64% were male, mean injury severity score (ISS) 18.7, and overall mortality rate 7%. According to our definition, 36% (1,092) of PICU admissions were preventable. Vehicular accidents (42%) were the most common injury mechanism and traumatic brain injury (83%) the most common injury. Compared to necessary admissions, preventable admissions were younger (6.9 vs. 7.6 years, p <0.001) with a lower median ISS (16 vs. 21, p<0.001), shorter median PICU LOS (17 vs. 41 hours, p<0.001) and shorter median hospital LOS (51 vs. 121 hours, p<0.001). 97% were eventually discharged home; 102 (0.05%) were discharged immediately from the PICU, with another 431 (40%) discharged within 48 hours of hospital admission. Conclusion: A significant number of children admitted to our PICU were classified as preventable and carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.

Objective: At the end of the presentation, the learner will be able to identify factors associated with pediatric intensive care unit admissions that might have been prevented.

Objective Content: Children with traumatic brain injuries were the most often preventable admission to the PICU. Such children may be observed in a non-PICU setting with more frequent neurological evaluations.

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