J Pediatr Intensive Care 2020; 09(01): 001-011
DOI: 10.1055/s-0039-3399581
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Time of Pediatric Intensive Care Unit Admission and Mortality: A Systematic Review and Meta-Analysis

1  Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India
,
1  Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India
2  Department of Telemedicine, Postgraduate Institute of Medical Research and Education, Chandigarh, India
,
2  Department of Telemedicine, Postgraduate Institute of Medical Research and Education, Chandigarh, India
,
1  Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India
,
Muralidharan Jayashree
1  Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India
,
Meenu Singh
1  Department of Pediatrics, Postgraduate Institute of Medical Research and Education, Chandigarh, India
2  Department of Telemedicine, Postgraduate Institute of Medical Research and Education, Chandigarh, India
› Author Affiliations
Funding This study was supported by the technical staff of Indian Council of Medical Research's Centre for Advanced Research (ICMR-CAR) in Evidence-Based Child Health. No monetary funding was obtained. The ICMR-CAR had obtained ethical clearance from the ethical committee of the Postgraduate Institute of Medical Research and Education, Chandigarh, India (vide number PGI/IEC/2018/002015 dated December 12, 2018).
Further Information

Publication History

12 August 2019

03 October 2019

Publication Date:
18 November 2019 (online)

Abstract

The aim of this study was to determine the association between the time of admission (day, night, and/or weekends) and mortality among critically ill children admitted to a pediatric intensive care unit (PICU). Electronic databases that were searched include PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Ovid, and Cochrane Library since inception till June 15, 2018. The article included observational studies reporting inhospital mortality and the time of admission to PICU limited to patients aged younger than 18 years. Meta-analysis was performed by a frequentist approach with both fixed and random effect models. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the quality of evidence. Ten studies met our inclusion criteria. Five studies comparing weekday with weekend admissions showed better odds of survival on weekdays (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.60–0.99). Pooled data of four studies showed that odds of mortality were similar between day and night admissions (OR: 0.93; 95% CI: 0.77–1.13). Similarly, three studies comparing admission during off-hours versus regular hours did not show better odds of survival during regular hours (OR: 0.77; 95% CI: 0.57–1.05). Heterogeneity was significant due to variable sample sizes and time period. Inconsistency in adjusting for confounders across the included studies precluded us from analyzing the adjusted risk of mortality. Weekday admissions to PICU were associated with lesser odds of mortality. No significant differences in the odds of mortality were found between admissions during day versus night or between admission during regular hours and that during off-hours. However, the evidence is of low quality and requires larger prospective studies.

Authors' Contributions

V.W. and N.J. contributed to protocol drafting, search strategy development, acquiring trial reports, trial selection, data extraction, data analysis, data interpretation, reviewing the draft, and future review updates. M.S. and M.J. contributed to protocol drafting, search strategy development, trial selection, data interpretation, reviewing the draft, and future review updates. A.C. contributed to data extraction, analysis and reviewing of the draft. P.P. contributed to search strategy development, executing and managing electronic searches, acquiring trial reports, trial selection, and future review updates.