Association between Hospital Volume and Within-Hospital Intensive Care Unit Transfer for Sickle Cell Disease in Children's Hospitals

Jean L. Raphael, Troy Richardson, Matt Hall, Suzette Olu Busola Oyeku, David G. Bundy, Ram V. Kalpatthi, Samir S. Shah, Angela M. Ellison

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD). Study design: We conducted a retrospective cohort study of 83 477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS. Results: Of 83 477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS. Conclusions: Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Apr 6 2015
Externally publishedYes

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Sickle Cell Anemia
Intensive Care Units
Length of Stay
Hospitalization
High-Volume Hospitals
Health Information Systems
Hospitalized Child
Linear Models
Cohort Studies
Retrospective Studies
Logistic Models
Databases
Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association between Hospital Volume and Within-Hospital Intensive Care Unit Transfer for Sickle Cell Disease in Children's Hospitals. / Raphael, Jean L.; Richardson, Troy; Hall, Matt; Oyeku, Suzette Olu Busola; Bundy, David G.; Kalpatthi, Ram V.; Shah, Samir S.; Ellison, Angela M.

In: Journal of Pediatrics, 06.04.2015.

Research output: Contribution to journalArticle

Raphael, Jean L. ; Richardson, Troy ; Hall, Matt ; Oyeku, Suzette Olu Busola ; Bundy, David G. ; Kalpatthi, Ram V. ; Shah, Samir S. ; Ellison, Angela M. / Association between Hospital Volume and Within-Hospital Intensive Care Unit Transfer for Sickle Cell Disease in Children's Hospitals. In: Journal of Pediatrics. 2015.
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abstract = "Objective: To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD). Study design: We conducted a retrospective cohort study of 83 477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS. Results: Of 83 477 eligible hospitalizations, 1741 (2.1{\%}) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95{\%} CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95{\%} CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95{\%} CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95{\%} CI 0.92-0.97) and SCD-specific (OR 0.86, 95{\%} CI 0.84-0.88), were associated with shorter LOS. Conclusions: Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.",
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AU - Richardson, Troy

AU - Hall, Matt

AU - Oyeku, Suzette Olu Busola

AU - Bundy, David G.

AU - Kalpatthi, Ram V.

AU - Shah, Samir S.

AU - Ellison, Angela M.

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N2 - Objective: To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD). Study design: We conducted a retrospective cohort study of 83 477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS. Results: Of 83 477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS. Conclusions: Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.

AB - Objective: To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD). Study design: We conducted a retrospective cohort study of 83 477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS. Results: Of 83 477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS. Conclusions: Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD.

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