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American Academy of Pediatrics
Brief Reports

Anticipating Pediatric Patient Transfers From Intermediate to Intensive Care

Daryl R. Cheng, Caitlyn Hui, Kate Langrish and Carolyn E. Beck
Hospital Pediatrics April 2020, 10 (4) 347-352; DOI: https://doi.org/10.1542/hpeds.2019-0260
Daryl R. Cheng
aDivision of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada;
bDepartment of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia;
cMurdoch Children’s Research Institute, Parkville, Victoria, Australia;
dDepartment of Paediatrics, University of Melbourne, Carlton, Victoria, Australia; and
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Caitlyn Hui
eFaculty of Medicine, and
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Kate Langrish
aDivision of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada;
fLawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Carolyn E. Beck
aDivision of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada;
gDepartment of Paediatrics,
hPediatric Outcomes Research Team and
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Abstract

OBJECTIVES: To explore characteristics of patients who were admitted to the intermediate care (IC) unit at a tertiary academic institution. In particular, we sought to compare the characteristics of IC patients who were transferred with the characteristics of those who were not transferred to PICU care and evaluate predictors of patient transfer.

METHODS: Data were collected on all admitted IC patients between July 2016 and June 2018. Patients whose index IC admission was from the PICU were excluded. Data collected included demographics and physiologic characteristics: heart rate, respiratory rate, temperature, oxygen therapy, as well as Bedside Pediatric Early Warning System (BPEWS) score.

RESULTS: In this time period, 427 eligible patient visits occurred, with 66 patients (15.46%) being transferred to the PICU. Patients were commonly transferred early in their IC course (1.41 days into admission [0.66–3.87]); transferred patients had higher median admission BPEWS scores (7 [4.25–9] vs 5 [3–7]; P < .01). In the univariate analysis, no individual physiologic characteristic was predictive for transfer. In the multivariate analysis, BPEWS (P < .001) and need for any form of respiratory support (P = .04) were significant predictive factors for transfer (R2 = 0.56).

CONCLUSIONS: The need for close monitoring of physiologic parameters remains paramount, especially in the first 48 hours of admission, in predicting the need for transfer from the IC to PICU. The need for any form of respiratory support is predictive of transfer. Situational awareness and assessment including BPEWS score is of critical importance.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (4)
Hospital Pediatrics
Vol. 10, Issue 4
1 Apr 2020
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Anticipating Pediatric Patient Transfers From Intermediate to Intensive Care
Daryl R. Cheng, Caitlyn Hui, Kate Langrish, Carolyn E. Beck
Hospital Pediatrics Apr 2020, 10 (4) 347-352; DOI: 10.1542/hpeds.2019-0260

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Anticipating Pediatric Patient Transfers From Intermediate to Intensive Care
Daryl R. Cheng, Caitlyn Hui, Kate Langrish, Carolyn E. Beck
Hospital Pediatrics Apr 2020, 10 (4) 347-352; DOI: 10.1542/hpeds.2019-0260
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