P2.099: PRE-PICU: Prehospital Primary Care Risk Factors for Critical Illness in Children

Background: Time spent in the pediatric intensive care unit (PICU) accounts for a large portion of healthcare costs and long-term sequelae seen in survivors and their families. These consequences of critical illness highlight the vital need for preventative practices within the pediatric healthcare system and community to reduce PICU admissions and prevent critical illness. Many prior studies have looked at factors affecting PICU admissions, however, it remains unknown whether the frequency of preventive primary care physician (PCP) visits is associated with risk of PICU admission. We hypothesize that patients admitted to the PICU will be more likely to have completed < 25% of recommended well child checks (WCC) by age than those discharged home from the ED or admitted to the general floors.

Methods: We completed a retrospective cohort study of patients seen at our hospital from 2011-2024 who also were patients at our associated pediatric primary care office prior to index hospital presentation. Patients were separated into three cohorts based on index hospitalization disposition: PICU admission (PICU), admitted to the general hospital floors (HOSP), or discharged home from the ED (ED). We report cohort membership, demographic information, and PCP utilization for WCC in the 2 years prior to index hospital presentation.

Results: We identified N=45,930 unique encounters across all three cohorts, with 83.5% from ED, 13.9% from HOSP, and 2.6% from PICU (Table 1). We found a significant difference in hospital length of stay and disposition between the HOSP and PICU cohorts. Hospitalization disposition was significantly associated with PCP utilization (x2: 230, p-value: < 0.001). Patients in the PICU cohort were less likely than those in the HOSP cohort and ED cohort to have completed >75% of WCC prior to admission [PICU: 19.8%, HOSP: 24.6%, ED: 30.5%] (Figure 1). Additionally, patients in the PICU cohort were more likely to have completed < 25% of WCC than those in the HOSP cohort and ED cohort [PICU: 8.8%, HOSP: 5.5%, ED: 5.2%]. All three cohorts had similar rates of PCP utilization between 51-75% [PICU: 31.2%, HOSP: 31.2%, ED: 32.5%].

Conclusion: We report a significant association between completed WCC prior to hospital presentation and hospitalization disposition amongst patients seen at our university associated PCP office. While our cohorts consisted of overall few patients who had < 25% completion of WCC prior to presentation (5.2% - 8.8%), the results do support our initial hypothesis. Planned additional analyses include stratifying demographic univariates by PCP utilization for WCC and multivariable regression analysis to measure factors associated with PICU vs. HOSP vs. ED disposition.