Regional variation in child mortality at hospitals lacking a pediatric intensive care unit

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Abstract
To investigate statewide variation in failure to utilize existing regional pediatric intensive care units (PICUs). Deaths of children in hospitals lacking specialized units (non-PICU hospitals) were postulated to represent possible PICU utilization failures. A survey study was performed on hospital inpatient discharges and deaths in 1997, using data obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Children 0–14 yrs old were studied, excluding neonatal Diagnosis-Related Groups and emergency department deaths. Hospitals were considered to have a PICU if they had a board-certified pediatric intensivist on staff, and either New York State designation as a PICU or a separate dedicated unit for children. Non-PICU hospital pediatric death rates were compared for health service areas to determine whether regional variation occurred. Statewide, 157 of 584 (27%) pediatric hospital inpatient deaths occurred in non-PICU hospitals. Significant variation was seen among eight regions in pediatric death rates in non-PICU hospitals (p < .05). The 114 of 328 (35%) New York City inpatient deaths occurring in non-PICU hospitals significantly exceeded the 43 of 256 (17%) throughout the remainder of the state (p < .05). New York City non-PICU hospital death rates also were higher than in the rest of the state, when expressed per 100,000 pediatric population (8.04 vs. 2.00), and per 1,000 non-PICU hospital discharges (2.25 vs. 1.18), respectively (p < .05). Forty percent of New York City non-PICU hospitals experienced a pediatric inpatient death compared with only 13% in the rest of the state (p < .05). Although the death of some children in hospitals lacking a PICU is expected, the significant regional variation in these deaths suggests that local obstacles, perhaps unique to metropolitan areas, may interfere with access to existing pediatric critical care resources.