A recent study showed that children who are admitted to pediatric intensive care units at regional medical centers tend to be sicker than children admitted directly from the center’s own emergency rooms.
The study, conducted by pediatric intensive care physicians at the UC Davis Children’s Hospital, examined over 13,000 records of patients admitted to pediatric ICUs. The patients were 18 years old or younger, and were admitted between January 2001 and January 2006.
The patients were assessed using the Pediatric Risk of Mortality score, said Dr. James Marcin, the study’s senior author.
Marcin, researcher of pediatric critical care medicine at the UCD Medical Center, said that score is a way of summarizing how sick a patient is in terms of their chances of death or survival.
“It takes into account things like vital signs, lab measures and physical exam findings,” he said. “It’s kind of a consumer report rate, but not how good your car is – it’s the chances of you dying.“
According to the study, children who were admitted to pediatric ICUs from smaller hospitals required a longer hospital stay of eight days. Those who were admitted directly from the center’s ER were hospitalized for an average of 6.7 days.
The study also provided statistics regarding other medical conditions that suggest patients coming from smaller hospitals tend to be sicker: 45 percent needed mechanical ventilation to help them breathe in comparison to 28.5 percent of patients who were transferred from within the center. Seven percent of children from the smaller hospitals needed medication to control their blood pressure and support their heart functions while only 5 percent of patients from the center’s emergency departments needed similar medication.
Possible reasons children admitted from the remote sites tend to be sicker could be because the doctors and nurses do not have resources or experience at those sites, Marcin said.
“When [patients] are in hospitals that don’t have a lot of resources, they may not get the optimal treatment right away,” he said.
Other reasons could be that people at the remote hospitals are sicker before they come to those emergency departments, Marcin said.
“People who live in rural areas and don’t have access to healthcare may come in more sick than children who live near hospitals or where they have easier access to hospitals and clinics,” he said.
The UCD Children’s Hospital hopes to improve situations by educating other pediatric hospitals and reaching out to the community. One way to do so is through telemedicine, the diagnosis and treatment of patients in remote areas through medical technology such as satellites.
“We, the UC Davis Medical Center, [are] an international leader in telemedicine in general,” Marcin said.
According to the UCD Children’s Hospital website, their pediatric critical care telemedicine program was the first of its kind in the United States. Programs include child abuse consultation and evaluation, child development, endocrinology, gastroenterology, oncology and hematology and psychiatry. Telemedicine also allows patients to communicate with their friends and family, interpreters and physicians.
“Rather than just getting a telephone call from a doctor, we’re able to talk to the family and see the patient to get a better assessment of how sick the child is,” he said.
Marcin said the UC Davis Children’s Hospital is committed to outreach and education in remote and underserved communities.
“Along with this commitment, we do things like go out [into] the community to give lectures to nurses and physicians for better treatment of sick children,” he said.
Marcin added that while many doctors at referral hospitals feel that other hospitals “dump” patients on them when patients don’t need to be hospitalized, data says that is not the case for children.
“I think that we need to be aware that community and rural hospitals don’t have the resources or experience to take care of sick children,” he said. “We have to be cognizant of that fact and recognize that on average, [children] are sicker when they come from outside hospitals.“
Outside hospitals have a lower threshold admitting these patients and the UCD Children’s Hospital is doing what they can to help, Marcin said.
For more information about the UCD Children’s Hospital, visit www.ucdmc.ucdavis.edu/children.
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