The development of a clinical markers score to predict readmission to paediatric intensive care

Intensive Crit Care Nurs. 2009 Dec;25(6):283-93. doi: 10.1016/j.iccn.2009.07.003. Epub 2009 Oct 12.

Abstract

Objective: Readmission to ICU following discharge is associated with increased length of stay (LOS), increased rates of mortality, morbidity and resource consumption. Reducing readmission rates is one of the key aims of the Intensive Care Unit liaison nurse (ICULN). Our objective was to identify factors associated with readmission which were identifiable both from demographics and from each LN visit, and from this develop a clinical markers score.

Methods: In this case control study, cases were all children who required ICU readmission within 48h of discharge over two years. The comparison group included children who were discharged on the same day as those who required readmission. Using multivariate logistic regression analysis the factors associated with ICU readmission were identified. The factors were further analysed for the development of the clinical markers score.

Results: The factors associated with readmission to ICU included high oxygen requirement, tachypnoea, age >10 years, age <2 weeks, LN assessment, high risk of readmission (ROR) score, longer LOS and admission under oncology.

Conclusion: From our study we found that the development of a score to predict the risk of readmission to ICU required a combination of subjective LN assessment, respiratory status and patient characteristics collected on discharge from ICU. This score can now be implemented and guide the LN to prioritise visits for children at increased risk of ICU readmission.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Critical Illness
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric*
  • Male
  • Nursing Assessment*
  • Patient Readmission*
  • Predictive Value of Tests
  • Risk Factors