Readmission risk factors for children admitted to pediatric intensive care unit with respiratory tract disease

Woo Jin Chung; Da Hye Yoon; Eui Gyung Lee; Kyong Won Bang; Hwan Su Kim; Yoon Hong Chun; Jong-Seo Yoon; Hyun Hee Kim; Jin Tack Kim; Joon Sung Lee

doi:10.4168/aard.2014.2.2.128

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Chung, Yoon, Lee, Bang, Kim, Chun, Yoon, Kim, Kim, and Lee: Readmission risk factors for children admitted to pediatric intensive care unit with respiratory tract disease

Original Article

Allergy, Asthma & Respiratory Disease 2014; 2(2): 128-133.

Published online: 31 May 2014

DOI: https://doi.org/10.4168/aard.2014.2.2.128

Readmission risk factors for children admitted to pediatric intensive care unit with respiratory tract disease

Woo Jin Chung, Da Hye Yoon, Eui Gyung Lee, Kyong Won Bang, Hwan Su Kim, Yoon Hong Chun, Jong-Seo Yoon, Hyun Hee Kim, Jin Tack Kim, Joon Sung Lee

Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Hyun Hee Kim. Department of Pediatrics, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, 327 Sosa-ro 327beon-gil, Wonmi-gu, Bucheon 420-717, Korea. Tel: +82-32-340-7046, Fax: +82-32-340-2314, hhkped@catholic.ac.kr

Received 2 December 2013 Revised 7 April 2014 Accepted 14 April 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression.

Methods

Among 286 children admitted to Seoul St. Mary's Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review.

Results

Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO₂)/fraction of inspiratory oxygen (FiO₂), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence.

Conclusion

For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO₂/FiO₂ can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor.

Keywords: Risk factors, Patient readmission, Respiratory tract disease, Pediatric intensive care unit

Figures and Tables

Fig. 1

Outline of participants of our study. Among 286 patients admitted to pediatric intensive care unit (PICU), 129 admitted with respiratory tract disease were enrolled. There was no patient died in first PICU admission. Of course, 8 patients readmitted to PICU with respiratory tract disease progression within 2 weeks were compared with the other 121 patients for clinical characteristics.

Table 1

The comparison of basic clinical characteristics, incidence of mortality and underlying disease at initial PICU admission between readmission group and control group

Values are presented as mean±standard deviation or number (%).

PICU, pediatric intensive care unit.

^*Mortality at PICU initial admission or readmission with respiratory tract disease.

^†Includes overlapped underlying disease.

Table 2

The comparison of characteristics of respiratory tract disease at initial PICU admission between readmission group and control group and those according to underlying disease existence

Values are presented as number (%), ratio (%), or mean±standard deviation.

PICU, pediatric intensive care unit; SpO₂, saturation by pulse oxymeter; FiO₂, fraction of inspiratory oxygen.

^*P-value according to underlying disease existence.

Table 3

Binary logistic regression analysis on variables of initial PICU admission, for pediatric intensive care unit readmission with respiratory tract disease progression within 2 weeks

PICU, pediatric intensive care unit; CI, confidence interval; SpO₂, saturation by pulse oxymeter; FiO₂, fraction of inspiratory oxygen.

^*Adjusted for underlying disease, parenchymal lung disease, oxygen subply, initial SpO₂/FiO₂ and ventilator care.

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