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Is Unplanned PICU Readmission a Proper Quality Indicator? A Systematic Review and Meta-analysis

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dc.contributor.author Prutsky, Gabriela J.
dc.contributor.author Padhya, Dipti
dc.contributor.author Ahmed, Ahmed T.
dc.contributor.author Almasri, Jehad
dc.contributor.author Farah, Wigdan H.
dc.contributor.author Prokop, Larry J.
dc.contributor.author Murad, M. Hassan
dc.contributor.author Alsawas, Mouaz
dc.date.accessioned 2021-04-13T20:51:04Z
dc.date.available 2021-04-13T20:51:04Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9245
dc.description.abstract CONTEXT: Unplanned PICU readmissions within 48 hours of discharge (to home or a different hospital setting) are considered a quality metric of critical care. OBJECTIVE: We sought to determine identifiable risk factors associated with early unplanned PICU readmissions. DATA SOURCES: A comprehensive search of Medline, Embase, the Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to July 16, 2018. STUDY SELECTION: Observational studies of early unplanned PICU readmissions (<48 hours) in children (<18 years of age) published in any language were included. DATA EXTRACTION: Two reviewers selected and appraised studies independently and abstracted data. A meta-analysis was performed by using the random-effects model. RESULTS: We included 11 observational studies in which 128 974 children (mean age: 5 years) were evaluated. The presence of complex chronic diseases (odds ratio 2.42; 95% confidence interval 1.06 to 5.55; I (2) 79.90%) and moderate to severe disability (odds ratio 2.85; 95% confidence interval 2.40 to 3.40; I (2) 11.20%) had the highest odds of early unplanned PICU readmission. Other significant risk factors included an unplanned index admission, initial admission to a general medical ward, spring season, respiratory diagnoses, and longer initial PICU stay. Readmission was less likely after trauma- and surgery-related index admissions, after direct admission from home, or during the summer season. Modifiable risk factors, such as evening or weekend discharge, revealed no statistically significant association. Included studies were retrospective, which limited our ability to account for all potential confounders and establish causality. CONCLUSIONS: Many risk factors for early unplanned PICU readmission are not modifiable, which brings into question the usefulness of this quality measure. en_US
dc.language.iso eng
dc.publisher American Academy of Pediatrics
dc.relation.ispartofseries Hospital Pediatrics
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Administration/Practice Management en_US
dc.subject Critical Care en_US
dc.subject Risk Management en_US
dc.title Is Unplanned PICU Readmission a Proper Quality Indicator? A Systematic Review and Meta-analysis en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1542/hpeds.2020-0192
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.03
dc.relation.issn 2154-1671


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