Feb 26, 2005

The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
James P MarcinJ Paul Leigh

Abstract

To evaluate the relation between annual pediatric intensive care unit (PICU) admission volume and mortality. Nonconcurrent cohort design. Pediatric patients included in the most currently available research database from the Pediatric Intensive Care Unit Evaluations (PICUEs). A total of 34,880 consecutive pediatric admissions to a contemporary volunteer sample of 15 U.S. PICUs. We conducted an instrumental variable analysis and adjusted for similarities between patients admitted to different PICUs using mixed-effects, hierarchical techniques. Case mix and severity of illness was adjusted for using patient-level data and the Pediatric Risk of Mortality, version III (PRISM III). On average, admission to higher-volume PICUs was associated with lower severity-adjusted mortality (odds ratio = 0.68 per 100 patient increase in volume; 95% confidence interval: 0.52-0.89) when volume was analyzed as a linear term; however, when PICU volume was analyzed as a quadratic term, we found the lowest severity-adjusted mortality rates among PICUs with annual admission volumes between 992 and 1,491. Furthermore, lower severity-adjusted mortality rates were primarily found among patients with less than a 10% PRISM III predicted risk of mortality. ...Continue Reading

  • References21
  • Citations23

References

  • References21
  • Citations23

Citations

Mentioned in this Paper

Pediatric Intensive Care Unit
Voluntary Admission
Incidence Studies
Hospital Mortality
Outcomes Research
Hospital Stay
Antineoplaston A10
Picus

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