• Folafoluwa O Odetola, Sarah J Clark, James G Gurney, Janet E Donohue, Achamyeleh Gebremariam, Lindsay DuBois, and Gary L Freed.
• Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: fodetola@med.umich.edu.
• J Crit Care. 2015 Oct 1; 30 (5): 1080-4.

PurposeOf all sources of admission to level I pediatric intensive care units (PICUs), interhospital transfer admissions from level II PICUs carry the highest mortality and resource use burden. We sought to investigate factors associated with transfer of children with respiratory failure from level II to level I PICUs.MethodsA case-control study was conducted among children with respiratory failure admitted to 6 level II PICUs between January 1, 1997, and December 31, 2007, with frequency matching of 466 nontransferred children (controls) to 187 transferred children (cases).ResultsAmong 653 children, transferred children were younger and had more comorbidities. After multivariable analysis, transferred children were more likely to have comorbidities (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.36-2.98) and receive escalated care including high-frequency ventilation (OR, 2.57; 95% CI, 1.04-6.37) and surfactant therapy (OR, 5.33; 95% CI, 1.35-21.0).ConclusionsThe study identified patient-level and process-of-care factors associated with transfer from level II to level I PICUs. These findings highlight the influence of escalated care on transfer decision making for critically ill children in respiratory failure.Copyright © 2015 Elsevier Inc. All rights reserved.

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