Association between evening admissions and higher mortality rates in the pediatric intensive care unit.

Yeseli Arias, Douglas S. Taylor, James P Marcin

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

BACKGROUND: Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population. OBJECTIVE: To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs. DESIGN/METHODS: We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score. PATIENTS: All 20,547 emergency PICU admissions made between May 1995 and December 2001 were included in the analyses. MAIN OUTCOME MEASURES: The primary outcome was death within 48 hours after admission to the PICU. RESULTS: Pediatric patients admitted to the PICU during evening hours had higher odds of death (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.00-1.62) than did those admitted during daytime hours. Subgroup analyses revealed higher odds of death among patients admitted with shock (OR: 4.09; 95% CI: 1.65-10.1), with congenital cardiovascular disease (OR: 3.90; 95% CI: 1.37-11.1), or after cardiac arrest (OR: 1.80; 95% CI: 1.04-3.13). There was no association between mortality rates and the day of admission (weekend admissions versus weekday admissions). CONCLUSIONS: An increased risk of death exists for some pediatric patients admitted to the PICU during evening hours. It remains necessary to determine whether this finding results from differences in the structure of care, processes of care, or both.

Original languageEnglish (US)
JournalPediatrics
Volume113
Issue number6
StatePublished - Jun 2004

Fingerprint

Pediatric Intensive Care Units
Mortality
Odds Ratio
Confidence Intervals
Pediatrics
Heart Arrest
Cluster Analysis
Shock
Emergencies
Cardiovascular Diseases
Logistic Models
Databases

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association between evening admissions and higher mortality rates in the pediatric intensive care unit. / Arias, Yeseli; Taylor, Douglas S.; Marcin, James P.

In: Pediatrics, Vol. 113, No. 6, 06.2004.

Research output: Contribution to journalArticle

@article{524451ac3c69438d8142d3e01a8aa297,
title = "Association between evening admissions and higher mortality rates in the pediatric intensive care unit.",
abstract = "BACKGROUND: Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population. OBJECTIVE: To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs. DESIGN/METHODS: We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score. PATIENTS: All 20,547 emergency PICU admissions made between May 1995 and December 2001 were included in the analyses. MAIN OUTCOME MEASURES: The primary outcome was death within 48 hours after admission to the PICU. RESULTS: Pediatric patients admitted to the PICU during evening hours had higher odds of death (odds ratio [OR]: 1.28; 95{\%} confidence interval [CI]: 1.00-1.62) than did those admitted during daytime hours. Subgroup analyses revealed higher odds of death among patients admitted with shock (OR: 4.09; 95{\%} CI: 1.65-10.1), with congenital cardiovascular disease (OR: 3.90; 95{\%} CI: 1.37-11.1), or after cardiac arrest (OR: 1.80; 95{\%} CI: 1.04-3.13). There was no association between mortality rates and the day of admission (weekend admissions versus weekday admissions). CONCLUSIONS: An increased risk of death exists for some pediatric patients admitted to the PICU during evening hours. It remains necessary to determine whether this finding results from differences in the structure of care, processes of care, or both.",
author = "Yeseli Arias and Taylor, {Douglas S.} and Marcin, {James P}",
year = "2004",
month = "6",
language = "English (US)",
volume = "113",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

TY - JOUR

T1 - Association between evening admissions and higher mortality rates in the pediatric intensive care unit.

AU - Arias, Yeseli

AU - Taylor, Douglas S.

AU - Marcin, James P

PY - 2004/6

Y1 - 2004/6

N2 - BACKGROUND: Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population. OBJECTIVE: To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs. DESIGN/METHODS: We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score. PATIENTS: All 20,547 emergency PICU admissions made between May 1995 and December 2001 were included in the analyses. MAIN OUTCOME MEASURES: The primary outcome was death within 48 hours after admission to the PICU. RESULTS: Pediatric patients admitted to the PICU during evening hours had higher odds of death (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.00-1.62) than did those admitted during daytime hours. Subgroup analyses revealed higher odds of death among patients admitted with shock (OR: 4.09; 95% CI: 1.65-10.1), with congenital cardiovascular disease (OR: 3.90; 95% CI: 1.37-11.1), or after cardiac arrest (OR: 1.80; 95% CI: 1.04-3.13). There was no association between mortality rates and the day of admission (weekend admissions versus weekday admissions). CONCLUSIONS: An increased risk of death exists for some pediatric patients admitted to the PICU during evening hours. It remains necessary to determine whether this finding results from differences in the structure of care, processes of care, or both.

AB - BACKGROUND: Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population. OBJECTIVE: To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs. DESIGN/METHODS: We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score. PATIENTS: All 20,547 emergency PICU admissions made between May 1995 and December 2001 were included in the analyses. MAIN OUTCOME MEASURES: The primary outcome was death within 48 hours after admission to the PICU. RESULTS: Pediatric patients admitted to the PICU during evening hours had higher odds of death (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.00-1.62) than did those admitted during daytime hours. Subgroup analyses revealed higher odds of death among patients admitted with shock (OR: 4.09; 95% CI: 1.65-10.1), with congenital cardiovascular disease (OR: 3.90; 95% CI: 1.37-11.1), or after cardiac arrest (OR: 1.80; 95% CI: 1.04-3.13). There was no association between mortality rates and the day of admission (weekend admissions versus weekday admissions). CONCLUSIONS: An increased risk of death exists for some pediatric patients admitted to the PICU during evening hours. It remains necessary to determine whether this finding results from differences in the structure of care, processes of care, or both.

UR - http://www.scopus.com/inward/record.url?scp=4344596219&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4344596219&partnerID=8YFLogxK

M3 - Article

C2 - 15173533

AN - SCOPUS:4344596219

VL - 113

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

ER -