| ObjectiveTo retrospectively analyze the clinical data of children admitted to pediatric intensive care unit(PICU),and explore the relationship between different sources of admission and the outcome of children.MethodsData related to children admitted to the PICU of Henan Provincial People’s Hospital from January 1,2021 to December 31,2021 were collected,and children were divided into four categories according to the source of admission: ward transfer group,emergency group,external access group,and outpatient group,and the effects of different sources of admission on child outcomes were retrospectively analyzed,and the characteristics and outcomes of children in the external access group were also compared under different time of admission and different transfer distances,We also compared the differences in the characteristics and outcomes of children in the external access group by time of admission and distance of transfer,and assessed the independent risk factors for mortality in the external access group.Data were entered using Excel 2010 and statistically analyzed using SPSS 26.0,and differences were considered statistically significant at P < 0.05.Results1.A total of 413 children were included in the study,and they were divided into four groups according to different sources of admission: emergency admission,outpatient admission,transfer from other wards of our hospital and admission from outside hospitals,with 141 cases(34.14%)、 14 cases(3.39%)、 115cases(27.85%)and 143(34.62%)cases,respectively.2.The types of diseases in our PICU were mainly neurological diseases(19.4%)、respiratory diseases(16.5%)and trauma(14.3%),and there were significant differences in the types of diseases in terms of seasons(P<0.01),neurological diseases(24.0%)and trauma were predominant in spring(19.2%),neonatal diseases in summer(24.8%),neurological diseases(21.2%)and respiratory diseases(20.2%)in autumn,and respiratory diseases in winter(30.6%).3.A total of 91 patients(22%)were critically and extremely critically ill PICU children in our hospital,and 322 patients(78%)were non-critically ill PICU children.4.There were significant differences in age、length of stay、pediatric critical illness score(PCIS)、disease type、duration of mechanical ventilation and child outcome among the four groups(P<0.05),and no significant differences in gender(P=0.328)and season of admission(P=0.378).5.Among 143 children admitted to our PICU,92(64.3%)were admitted during daytime and 51(35.7%)were admitted during nighttime,and there was no significant difference between daytime and nighttime admissions in terms of age、gender、duration of mechanical ventilation、PCIS、length of stay、season、referral distance and outcome(P>0.05);most of the children in the external access group were referred at a distance of 150-250km(59%),and there were significant differences in the outcomes(P=0.021)and PCIS(P=0.023)of children referred at different referral distances,and no significant differences in age、sex、duration of mechanical ventilation、length of hospitalization、referral time and season of admission(P>0.05).6.Regarding the effect of admission source on outcome,there was no significant relationship between different admission sources on the outcome of children who were not completely cured(P>0.05),while there was a significant effect of different admission sources on the outcome of death of children(P=0.003).25 children died in our PICU in 2021,including 8 deaths(32%)in the ward transfer group,15 deaths(60%)in the external access group,and 2 deaths(8%)in the emergency,There were no deaths in the outpatient group,and the risk of death was highest in the external access group.7.Binary logistic regression analysis showed that the independent risk factors for death in the external access group were length of stay(P=0.005)、 gender(P=0.018)、 duration of mechanical ventilation >1 day(P=0.004)and PCIS ≤80(P≤0.028);there was no statistically significant difference in PCIS scores among children of different genders in the external access group(P>0.05),but the total percentage of critically and very critically ill children was higher in males(31.5%)than in females(28.6%).Conclusion1.Children in PICU of our hospital mainly external hospital access,originated from emergency,transfer from other wards,and the disease types were mainly neurological diseases,respiratory diseases and trauma,and the disease distribution was seasonal.2.length of hospitalization、gender、duration of mechanical ventilation >1 day、and PCIS≤80 were independent risk factors for death of children in the external access group.3.Different sources of admission have an impact on the outcome of children in PICU,and children in the external access group have the highest risk of death,and the worst outcome,suggesting that we need to develop and popularize referral criteria for critically ill children and establish a transfer system so that children can be referred and treated effectively in a timely manner to minimize the risk of death in the receiving children. |
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