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.
Keywords
pediatric - intensive care - critical care - time of admission - mortality
