Does admission time matter in a paediatric intensive care unit? A prospective cohort study

Abstract

Aim Studies assessing the association between admission time to paediatric intensive care unit (PICU) and mortality are sparse with conflicting results. We aimed to evaluate the impact of time of admission on PICU mortality within 48 h after admission. Methods This was a single‐centre prospective cohort. We collected data from all consecutive children aged 1 month to 16 years over 10 years. Results We included a total of 1368 admissions, with a PICU mortality of 6.6%. Compared with daytime admissions, the overall mortality rate (5.3% vs. 8.5%, P = 0.026) and the mortality within 48 h after admission were higher for those admitted during night‐time (2% vs. 4.2%, P = 0.021). There were no differences between mortality rates and the day of admission (weekend admissions vs. weekday admissions). The adjusted odds of death within 48 h after admission was 2.5 (95% confidence interval = 1.22–5.24, P = 0.012) for patients admitted at night‐time. A secondary analysis assessing trends in mortality rates during admission showed that the last 5 years of study were more responsible for the chances of death within 48 h (odds ratio = 7.6, 95% confidence interval = 1.91–30.17, P = 0.0039). Conclusion Admission to the PICU during night shifts was strongly associated with death compared to daytime admissions. A time analysis of the moment of admission is necessary as a metric of quality of care to identify the interruption or improvement in the continuity of care. Further studies are needed to assess the modified contributing factors.

Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns

“…Repletion regimens vary by institution, individual patient factors, and provider factors, resulting in clinical treatment following hospital routine and not the patients' needs [15]. This may result in the delivery of interrupted care during the day due to work organization and non-clinical indicators [22][23][24]. The local culture in electrolyte replacement may be another factor influencing decision making for electrolyte replacement.…”