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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 13 of 13 Research Studies Displayed
Haidari ES, Lee HC, Illuzzi JL
Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category.
The objective of this study was to examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation. 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. The authors concluded that interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses.
Citation: Haidari ES, Lee HC, Illuzzi JL . Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category. J Perinatol 2021 Mar;41(3):468-77. doi: 10.1038/s41372-020-00775-z..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Hospitalization, Hospitals
Logan GE, Sahrmann JM, Gu H
Parental mental health care after their child's pediatric intensive care hospitalization.
Pediatric intensive care unit (PICU) hospitalization is traumatic for parents, and PTSD, depression, and anxiety have all been found in parents of PICU survivors. This retrospective observational cohort study examined parents of PICU survivors using insurance claims data from 2006 to 2013. Rates of mental health diagnoses, outpatient mental health visits, and prescriptions for antidepressants and anxiolytics were looked at 6 months before and 6 months after their child’s PICU admission. Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after PICU hospitalization with mothers twice as likely to receive a new mental health diagnosis or take new medication than fathers. Parental diagnosis of acute stress disorder or PTSD increased by 87% from the pre-PICU to the post-PICU period.
Citation: Logan GE, Sahrmann JM, Gu H . Parental mental health care after their child's pediatric intensive care hospitalization. Pediatr Crit Care Med 2020 Nov;21(11):941-48. doi: 10.1097/pcc.0000000000002559..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Hospitalization, Caregiving, Behavioral Health, Family Health and History
Poppert Cordts KM, Hall TA, Hartman ME
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
Citation: Poppert Cordts KM, Hall TA, Hartman ME . Sleep measure validation in a pediatric neurocritical care acquired brain injury population. Neurocrit Care 2020 Aug;33(1):196-206. doi: 10.1007/s12028-019-00883-5..
Keywords: Children/Adolescents, Sleep Problems, Neurological Disorders, Intensive Care Unit (ICU), Hospitalization, Quality of Life
Lindell RB, Nishisaki A, Weiss SL
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
This study’s objective was to assess the risk of mortality for immunocompromised children admitted to the hospital with septic shock or sepsis. This retrospective multicenter cohort study used eighty-three centers in the Virtual Pediatric systems database. The cohort included children admitted to the pediatric intensive care unit (PICU) with severe sepsis or septic shock from 2012-2016. Across 83 centers, 10,768 PICU admissions with an International Classification of Diseases, 9th Revision, Clinical Modification code for severe sepsis or septic shock were identified; with 3,021 of these patients (28%) having an immunocompromised diagnosis. PICU mortality rates varied widely by center, and those centers with a higher mean number of sepsis patients per month in a center had a lower PICU mortality rate. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are conditions independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock.
AHRQ-funded; HS024511; HS026939; HS021583; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL . Risk of mortality in immunocompromised children with severe sepsis and septic shock. Crit Care Med 2020 Jul;48(7):1026-33. doi: 10.1097/ccm.0000000000004329..
Keywords: Children/Adolescents, Mortality, Sepsis, Risk, Intensive Care Unit (ICU), Hospitalization, Hospitals
Hussain FS, Sosa T, Ambroggio L
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
This case-control study aimed to determine the predictive validity of an emergency transfer (ET) for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
Citation: Hussain FS, Sosa T, Ambroggio L . Emergency transfers: an important predictor of adverse outcomes in hospitalized children. J Hosp Med 2019 Aug;14(8):482-85. doi: 10.12788/jhm.3219..
Keywords: Transitions of Care, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Outcomes, Patient-Centered Outcomes Research, Inpatient Care, Hospitalization, Hospitals, Healthcare Delivery
Barbash IJ, Wallace DJ, Kahn JM
Effects of changes in ICU bed supply on ICU utilization.
The purpose of this study was to determine the relationship between intensive care unit (ICU) bed supply and ICU admission in US hospitals. Using a difference-in-differences approach, researchers compared the risk-adjusted probability of ICU admission at hospitals that increased their ICU bed supply over time with matched hospitals that did not. Subjects were three patient groups with a low likelihood of benefiting from ICU admission: low-severity patients with acute myocardial infarction and pulmonary embolism, and high-severity patients with metastatic cancer at the end of life. Results showed that increases in ICU bed supply were associated with inconsistent changes in the probability of ICU admission that varied across patient subgroups.
Citation: Barbash IJ, Wallace DJ, Kahn JM . Effects of changes in ICU bed supply on ICU utilization. Med Care 2019 Jul;57(7):544-50. doi: 10.1097/mlr.0000000000001137..
Keywords: Intensive Care Unit (ICU), Critical Care, Healthcare Utilization, Hospitalization, Healthcare Delivery, Hospitals
Sudduth CL, Overton EC, Lyu PF
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, researchers sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. They concluded that selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94 percent authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay.
Citation: Sudduth CL, Overton EC, Lyu PF . Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol. J Crit Care 2017 Jun;39:220-24. doi: 10.1016/j.jcrc.2017.01.012.
Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Hospitalization, Sepsis
Admon AJ, Wunsch H, Iwashyna TJ
Hospital contributions to variability in the use of ICUs among elderly Medicare recipients.
Hospitals vary widely in ICU admission rates across numerous medical diagnoses. In This retrospective cohort study examined the extent to which variability in ICU use is specific to individual diagnoses or is a function of the hospital, regardless of disease. The authors concluded that hospitals account for a significant proportion of variation independent of measured patient and hospital characteristics, suggesting the need for further work to evaluate the causes of variation at the hospital level and potential consequences of variation across hospitals.
Citation: Admon AJ, Wunsch H, Iwashyna TJ . Hospital contributions to variability in the use of ICUs among elderly Medicare recipients. Crit Care Med 2017 Jan;45(1):75-84. doi: 10.1097/CCM.0000000000002025..
Keywords: Elderly, Hospitalization, Hospitals, Intensive Care Unit (ICU), Medicare
Sjoding MW, Prescott HC, Wunsch H
Longitudinal changes in ICU admissions among elderly patients in the United States.
The researchers sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. They ound that patients with infectious diseases increased from 8.8 percent to 17.2 percent of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010.
Citation: Sjoding MW, Prescott HC, Wunsch H . Longitudinal changes in ICU admissions among elderly patients in the United States. Crit Care Med 2016 Jul;44(7):1353-60. doi: 10.1097/ccm.0000000000001664.
Keywords: Elderly, Intensive Care Unit (ICU), Hospitalization, Diagnostic Safety and Quality, Critical Care
Hasvold J, Sjoding M, Pohl K
The role of human metapneumovirus in the critically ill adult patient.
The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). It concluded that although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated with serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.
Citation: Hasvold J, Sjoding M, Pohl K . The role of human metapneumovirus in the critically ill adult patient. J Crit Care 2016 Feb;31(1):233-7. doi: 10.1016/j.jcrc.2015.09.035.
Keywords: Critical Care, Respiratory Conditions, Intensive Care Unit (ICU), Hospitalization
Nagendran M, Dimick JB, Gonzalez AA
Mortality among older adults before versus after hospital transition to intensivist staffing.
The researchers sought to determine whether hospitals can reduce their mortality by adopting an intensivist staffing model. Adoption of an intensivist staffing model was not associated with improved mortality in Medicare beneficiaries. These findings suggest that the lower mortality rates previously observed at hospitals with intensivist staffing may be attributable to other factors.
AHRQ-funded; HS023621; HS024403.
Citation: Nagendran M, Dimick JB, Gonzalez AA . Mortality among older adults before versus after hospital transition to intensivist staffing. Med Care 2016 Jan;54(1):67-73. doi: 10.1097/mlr.0000000000000446.
Keywords: Mortality, Elderly, Intensive Care Unit (ICU), Hospitalization, Critical Care
Chen R, Strait KM, Dharmarajan K
Hospital variation in admission to intensive care units for patients with acute myocardial infarction.
This study investigates how contemporary hospitals use this resource-intensive setting of intensive care units (ICUs) and whether higher use is associated with better outcomes. It found that rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies.
Citation: Chen R, Strait KM, Dharmarajan K . Hospital variation in admission to intensive care units for patients with acute myocardial infarction. Am Heart J 2015 Dec;170(6):1161-9. doi: 10.1016/j.ahj.2015.09.003.
Keywords: Hospitalization, Intensive Care Unit (ICU), Heart Disease and Health
Valley TS, Sjoding MW, Ryan AM
Association of intensive care unit admission with mortality among older patients with pneumonia.
The purpose of this study was to estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. It concluded that among Medicare beneficiaries hospitalized with pneumonia, ICU admission of patients for whom the decision appeared to be discretionary was associated with improved survival and no significant difference in costs.
Citation: Valley TS, Sjoding MW, Ryan AM . Association of intensive care unit admission with mortality among older patients with pneumonia. JAMA 2015 Sep 22-29;314(12):1272-9. doi: 10.1001/jama.2015.11068..
Keywords: Patient Safety, Intensive Care Unit (ICU), Elderly, Mortality, Hospitalization