• Mohd Nizam Mat Bah, Sharifah Adlena Syed Mohamed, Nisah Abdullah, and Emieliyuza Yusnita Alias.
• All authors: Department of Pediatrics, Hospital Sultanah Aminah Johor Bahru, Johor DT, Ministry of Health, Johor, Malaysia.
• Pediatr Crit Care Me. 2020 Nov 1; 21 (11): e959-e966.

ObjectivesTo study the rate of unplanned PICU readmission, determine the risk factors and its impact on mortality.DesignA single-center retrospective cross-sectional study.SettingTertiary referral PICU in Johor, Malaysia.PatientsAll children admitted to the PICU over 8 years were included. Patients readmitted into PICU after the first PICU discharge during the hospitalization period were categorized into "early" (within 48 hr) and "late" (after 48 hr), and factors linked to the readmissions were identified. The mortality rate was determined and compared between no, early, and late readmission.InterventionsNone.Measurements And Main ResultsThere were 2,834 patients in the study with 70 early and 113 late readmissions. Therefore, the rate of early and late PICU readmission was 2.5% (95% CI, 1.9-3.0%) and 3.9% (95% CI, 3.2-4.7%), respectively. The median length of stay of the second PICU admission for early and late readmissions was 2.7 days (interquartile range, 1.1-7.0 d) and 3.2 days (interquartile range, 1.2-7.5 d), respectively. The majority of early and late readmissions had a similar diagnosis with their first PICU admission. Multivariable multinomial logistic regression revealed a Pediatric Index Mortality 2 score of greater than or equal to 15, chronic cardiovascular condition, and oxygen supplement upon discharge as independent risk factors for early PICU readmission. Meanwhile, an infant of less than 1 year old, having cardiovascular, other congenital and genetic chronic conditions and being discharged between 8 AM and 5 PM was an independent risk factor for late readmission. There was no significant difference in the mortality rate of early (12.9%), late (13.3%), and no readmission (10.7%).ConclusionsDespite the lack of resources and expertise in lower- and middle-income countries, the rate and factors for PICU readmission are similar to those in high-income countries. However, PICU readmission has no statistically significant association with mortality.

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