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American Academy of Pediatrics
Research Articles

Here and Gone: Rapid Transfer From the General Care Floor to the PICU

Kathryn O. Mansel, Sophia W. Chen, April A. Mathews, M. David Gothard and Michael T. Bigham
Hospital Pediatrics September 2018, 8 (9) 524-529; DOI: https://doi.org/10.1542/hpeds.2017-0151
Kathryn O. Mansel
aDepartments of Medical Education and
bPediatrics,
cDivisions of Pediatric Hospital Medicine and
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Sophia W. Chen
bPediatrics,
cDivisions of Pediatric Hospital Medicine and
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April A. Mathews
aDepartments of Medical Education and
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M. David Gothard
eBiostats Inc, Canton Ohio
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Michael T. Bigham
bPediatrics,
dCritical Care Medicine, Akron Children’s Hospital, Akron Ohio; and
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    TABLE 1

    Non-RT and RT Patient Demographics

    VariableNon-RT, N = 345RT, N = 105P
    Age, mo.74
     Mean (SD)90.7 (97.66)94.3 (92.09)
     Median5972
     Min–max0–7610–423
    Wt, kg.81
     Mean (SD)28.7 (26.19)29.4 (25.02)
     Median17.819.2
     Min-max2.5–113.92.2–98.3
    PRISM III score.71
     Mean (SD)2.56 (3.89)2.4 (3.64)
     Median00
     Min-max0–200–26
    PIM2 ROM score.83
     Mean (SD)1.51 (2.50)1.58 (3.60)
     Median0.870.84
     Min-max0.16–22.960.11–35.1
    Baseline POPC, n (%)
     1: good140 (40.6%)55 (52.4%)—
     2: mild70 (20.3%)23 (21.9%)—
     3: moderate73 (21.2%)14 (13.3%)—
     4: severe61 (17.7%)13 (12.4%)—
     5: coma1 (0.3%)0—
     6: brain death00—
    Median (IQR)2 (1–3)1 (1–3).01
    • P values from independent samples Student’s t tests except for baseline POPC comparison which employed the Mann–Whitney U test. Min-max, minimum-maximum; —, not applicable.

    • View popup
    TABLE 2

    Service Line and Origin of Admission for Non-RT and RT Patients

    VariableNon-RT, N = 345RT, N = 105P
    Service line, n (%).362
     Pediatric hospital medicine152 (44.1)56 (53.3)
     Medical subspecialties148 (42.9)39 (37.1)
     Pediatric surgery17 (4.9)3 (2.9)
     Surgical subspecialties28 (8.1)7 (6.7)
    Origin of admission, n (%).033
     Direct admission28 (8.1)14 (13.3)
     ED132 (38.3)41 (39.0)
     PACU52 (15.1)14 (13.3)
     PICU64 (18.6)a7 (6.7)a
     Transport44 (12.8)20 (19.0)
     Other25 (7.2)9 (8.6)
    Direct admission or transport origin of admission, n (%)72 (20.9)34 (32.4).010
    • Medical subspecialties include pulmonology, hematology oncology, adolescent, neurology, cardiology, endocrinology, allergy immunology, nephrology, gastroenterology, rheumatology, and palliative care. Surgical subspecialties include otolaryngology, plastic surgery, urology, and neurosurgery. Other includes on-site primary care and subspecialty clinics and Metro Life flight or other transport. P values from Pearson χ2 tests with Bonferroni adjusted P values. PACU, postanesthesia care unit.

    • ↵a Significant heterogeneous subcategory.

    • View popup
    TABLE 3

    Multivariate Logistic Regression for RT Outcome

    FactorFull Model OR (95% CI)PReduced Model OR (95% CI)P
    Constant0.451.0020.526.005
    PICU origin of admission0.383 (0.166–0.881).0240.347 (0.153–0.789).012
    Direct admission or transport origin of admission1.424 (0.860–2.355).169——
    Baseline POPC0.830 (0.673–1.025).0830.810 (0.659–0.996).046
    • Significantly associated (P < .05) univariate factors were selected for multivariate logistic regression. Stepwise elimination reduced the model to significant factors (P < .05). Insignificant Hosmer-Lemeshow test supports reduced model (P = .961, χ2 = 0.620, df = 4). df, degrees of freedom; —, not applicable.

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    TABLE 4

    Non-RT and RT Patient Mortality, LOS, and Emergency Transfer

    VariableNon-RT, N = 345RT, N = 105P
    Mortality, n (%)11 (3.2%)2 (1.9%).74
    LOS, d<.001
     Mean (SD)5.5 (12.01)2.8 (3.75)
     Median2.41.5
     Min-max0.1–144.50.2–25.7
    Emergency transfer, n (%)26 (7.5%)16 (15.2%).018
    • P value for mortality and emergency transfer comparisons via Pearson χ2 tests. LOS was compared for rank equality via Mann–Whitney U test. Min-max, minimum-maximum.

    • View popup
    TABLE 5

    Severity of Illness Scores and Mortality in RT Patients in the Presence and Absence of Emergency Transfer

    Subgroup or VariableEmergency Transfer and RT, N = 16Nonemergency Transfer and RT, N = 89P
    Severity of illness score
     Baseline POPC, median (IQR)1 (1–2.75)1 (1–3).701
     PIM2 ROM, median (IQR)2.11 (0.87–4.40)0.82 (0.19–1.09).001
     PRISM III, median (IQR)4 (0.25–9.25)0.00 (0–3).003
    Mortality, n (%)2 (12.5%)0 (0%).022
    • P values from baseline POPC, PIM2 ROM, PRISM III comparisons via Mann–Whitney U tests. Results are reported as median (IQR) because of small sample size. Mortality was compared via Fisher’s exact tests.

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Hospital Pediatrics: 8 (9)
Hospital Pediatrics
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1 Sep 2018
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Here and Gone: Rapid Transfer From the General Care Floor to the PICU
Kathryn O. Mansel, Sophia W. Chen, April A. Mathews, M. David Gothard, Michael T. Bigham
Hospital Pediatrics Sep 2018, 8 (9) 524-529; DOI: 10.1542/hpeds.2017-0151

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Here and Gone: Rapid Transfer From the General Care Floor to the PICU
Kathryn O. Mansel, Sophia W. Chen, April A. Mathews, M. David Gothard, Michael T. Bigham
Hospital Pediatrics Sep 2018, 8 (9) 524-529; DOI: 10.1542/hpeds.2017-0151
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