Return-to-Care After Discharge Directly Home From the PICU: A Propensity-Matched Cohort Study
Bibliographic record
Abstract
OBJECTIVES: To compare the proportion of PICU patients returning to the emergency department (ED) or readmitted within 14 days of hospital discharge, between those discharged directly home from the PICU and those transferred to acute care before discharge home; we hypothesized that rates of return-to-care would be similar. DESIGN: Propensity-matched multicenter cohort study. SETTING: Forty-five U.S. hospitals participating in Pediatric Health Information Systems. PATIENTS: Children admitted to a non-neonatal cardiac or PICU from 2016 to 2023. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 560,815 PICU discharges, 150,126 (26.8%) were discharged directly home, although this proportion varied by center (9.8-55.6%). We matched 94,048 children (62.6%) discharged directly home to 153,887 ward-transferred children at admission year, admission type, principal diagnosis, and a propensity score estimating the likelihood of being discharged directly home. Compared with ward-transferred peers, children discharged directly home had similar rates of return-to-ED care (2.9% vs. 3.0%; odds ratio [OR], 0.94 [0.89-0.99]) and hospital readmission (4.8% vs. 4.9%; OR, 0.97 [0.94-1.01]) within 14 days. Once readmitted, however, children discharged directly home were more likely to be readmitted to a PICU (2.4% vs. 1.6%; OR, 1.58 [1.49-1.67]). Costs for the index hospitalization were lower for children discharged directly home compared with ward-transferred peers, leading to lower inpatient healthcare costs over 14 days (median, 15,023 [7,614.5-34,294.6] vs. 30,750 [14,558.3-68,830.6]; p ≤ 0.001). CONCLUSIONS: Discharge directly home from the PICU is common; children discharged directly home have comparable likelihood of return-to-ED or inpatient care as matched, ward-discharged peers. Discharge directly home for appropriate patients may provide increased efficiency for healthcare systems.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".