Long Stay and Frequent Readmission in the Pediatric Intensive Care in The Netherlands; 15-Year Time Trends

Liz van de Riet; Marieke H Otten; Clara D van Karnebeek; Job B M van Woensel

doi:10.1097/CCE.0000000000000798

Long Stay and Frequent Readmission in the Pediatric Intensive Care in The Netherlands; 15-Year Time Trends

Crit Care Explor. 2022 Dec 5;4(12):e0798. doi: 10.1097/CCE.0000000000000798. eCollection 2022 Dec.

Authors

Liz van de Riet^{1

2

3}, Marieke H Otten¹, Clara D van Karnebeek^{2

3

4}, Job B M van Woensel^{1

3}

Affiliations

¹ Department of Pediatric Intensive Care, Amsterdam UMC location University of Amsterdam, Pediatric Intensive Care Unit, Amsterdam, The Netherlands.
² Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.
³ Transitional Care Unit Consortium, The Netherlands.
⁴ Departments of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.

Abstract

To describe time trends and the burden of long-stay patients (LSP) and frequent-readmission patients (FRP) in the PICUs in The Netherlands.

Design: Retrospective analysis of data from the nationwide Pediatric Intensive Care Evaluation registry including all PICU admissions in The Netherlands.

Setting: All PICUs in The Netherlands.

Patients: All PICU patients less than 18 years old admitted between 2003 and 2017. Two groups of patients were identified: LSP (admitted ≥30 d) and FRP (≥3 readmissions within the first year after their first admission).

Interventions: None.

Measurements and main results: A total of 47,424 children were admitted on 59,759 occasions. LSP (3.3% of total cohort) and FRP (2.1%) accounted for 37.5% and 14.5% of cumulative admission days, respectively. Patients fulfilling both LSP and FRP criteria (0.6%) accounted for 9.9% of cumulative admission days. No significant time trends were observed between 2003 and 2017 for the number of LSP and FRP, nor for accounted cumulative admission days. Age and disease severity-adjusted mortality was significantly higher for LSP (odds ratio [OR], 2.16; 95% CI, 1.66-2.82; p < 0.001) and FRP OR 1.40 (95% CI, 0.97-2.01; p = 0.069) compared with the general PICU population. Overall PICU mortality decreased significantly between 2003 (6.5%) and 2017 (3.7%; p = 0.004), but remained constant over time for both LSP (17.2%) and FRP (6.3%).

Conclusions: The proportion of LSP and FRP and their burden on PICU capacity are considerable and remained constant between 2003 and 2017. Whereas age and disease severity-adjusted mortality decreased in the general PICU population, it did not change in LSP and FRP.

Keywords: bed occupancy; length of stay; pediatric intensive care unit; pediatric intensive care unit mortality; pediatric intensive care unit readmissions.