Predictors for Home Discharge and Need for Medical Care at Home in Paediatric ICU Patients: A Single-Centre Retrospective Study.
Misuzu Oyagi, Shigeki Bamba, Kohei Takashima and 5 others
PMID 41731587WHAT IT FOUND
Postoperative admission and lower admission heart rate were linked to a higher chance of direct home discharge in 118 paediatric ICU patients; arrest before ICU and early ventilation were linked to a lower chance.
Longer ICU stay was linked to needing medical care at home.
Key findings
01In 118 analysed paediatric ICU patients, postoperative admission and lower admission heart rate were independent predictors of direct home discharge, while pre-admission arrest and early mechanical ventilation were associated with lower likelihood.
02Among the 82 children eligible for home discharge, longer ICU stay was associated with needing medical care at home; 7 of 12 patients staying 12 days or more required additional care.
03The additional home medical care needed included tracheostomy in 5 patients, gastrostomy in 3 patients and mechanical ventilation in 2 patients, with overlap.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-centre retrospective design may favour more critically ill patients and limits generalisability. Small sample, 118 analysed, may reduce statistical power and widen confidence intervals. Outcomes for patients transferred to other hospitals could not be tracked. Established severity scores such as PIM2 or PIM3 were not calculated because some variables were missing from records. Heart rate was a weak stand-alone predictor; the 131 bpm cut-off had modest sensitivity and specificity. ICU length of stay was a secondary signal and is not known at admission. The 12-day length-of-stay cut-off was not statistically significant (p = 0.067).
Declared interests
The authors report no conflicts of interest and no funding to report.
The easy way to misread this
Do not treat the 131 bpm heart rate cut-off or the 12-day ICU stay signal as validated predictors. The study was retrospective, single-centre and small; the heart rate effect was small, and the length-of-stay cut-off was not statistically significant.