May 23, 2013
1 min read

Increased mortality risk in PICU admissions during winter

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Children admitted to the pediatric ICU out-of-hours are not at an increased risk of dying compared with those admitted during normal hours, according to recent study results published in The Journal of Pediatrics.

“The consistency of the quality of care provision by all PICUs at any time during the week will be very reassuring for the parents of children requiring intensive care,” study researcher Elizabeth S. Draper, PhD, of the University of Leicester in the United Kingdom, said in a press release.

The study included more than 86,000 admissions to 29 PICUs from 2006 to 2011. Researchers used multivariate logistic regression modeled risk-adjusted mortality before discharge with night, weekend and public holiday admissions, admissions per unit, winter admission, and potential confounders for emergency and planned admissions.

Researchers found that 47.1% of admissions were out-of-hours and 79.2% were emergencies.

Also, mortality for out-of-hours admissions was increased (OR=1.1; 95% CI, 1.02-1.2), explained by planned admissions (OR=1.99; 95% CI, 1.67-2.37) and decreased risk for emergency admissions (OR=0.93; 95% CI, 0.86-1.1). Winter admissions had a 13% increased risk of mortality. “The increase of winter mortality is not due to children being sicker in winter, as we have taken that into account in our analysis as far as possible,” Draper said.

According to researchers, the strain on units’ resources and staff could be having an effect, as PICUs often experience high admissions during the winter. Respiratory syncytial virus is more common during the winter, and admissions due to it can put pressure on services.

“It is not clear why we are seeing this effect in winter,” study researcher Roger C. Parslow, PhD, of the University of Leeds’ School of Medicine, said in a press release. “It could be pressure on services, but it could be that we are looking at a different mix of patients. When units are under great pressure, less seriously ill children may be cared for in other specialist areas in the hospital. That would mean the proportion of children in intensive care with life-threatening problems is greater, and it is possible that our risk-adjustment model may not fully take this into account. This is a topic for further research.”

Disclosure: The researchers report no relevant financial disclosures.