# Predictors for Home Discharge and Need for Medical Care at Home in Paediatric ICU Patients: A Single‐Centre Retrospective Study

## TL;DR

This study identifies factors that predict whether children in the ICU can be discharged home and whether they will need ongoing medical care at home.

## Contribution

The study provides new admission-time predictors for home discharge and home medical care needs in pediatric ICU patients.

## Key findings

- Postoperative admission, lower heart rate, absence of pre-admission cardiopulmonary arrest, and no early mechanical ventilation predict home discharge.
- A heart rate threshold of 131 bpm at ICU admission is associated with likelihood of home discharge.
- Longer ICU stays (around 12 days) are linked to the need for home medical care.

## Abstract

The number of children with medical complexity at home has been increasing. To facilitate a smooth transition to home care for these children after discharge from the intensive care unit (ICU), early nursing interventions and family training are essential.

This study examined factors that predict home discharge and the need for medical care at home using routine clinical information at the time of ICU admission.

This study included paediatric patients under the age of 16 who were admitted to the ICU. Clinical data were extracted from medical records. Univariate and multivariate analyses were conducted using logistic regression to identify relevant factors. Receiver operating characteristic (ROC) analysis was performed to determine the cut‐off values.

One hundred and thirty‐one patients were included, of whom 82 patients were discharged home. Multivariate analysis using logistic regression identified the following independent predictors of home discharge: postoperative admission (p = 0.024), lower heart rate at admission (p = 0.016), absence of cardiopulmonary arrest immediately before ICU admission (CPA) (p = 0.012) and no mechanical ventilation within the first hour of ICU admission (p = 0.044). ROC analysis for heart rate at admission yielded a cut‐off value of 131 bpm (p = 0.039). A total of 62 patients did not require home medical care. Univariate logistic regression analysis identified length of ICU stay as a significant factor associated with the need for home medical care (p = 0.045).

In paediatric ICU patients, postoperative admission, lower heart rate at admission, absence of pre‐admission CPA and no mechanical ventilation predicted successful home discharge. The need for home medical care was significantly associated with length of ICU stay.

Early and appropriate nursing interventions can be considered for paediatric ICU patients and their families, leading to the provision of high‐quality nursing care.

What is known about this topic
○The number of children with medical complexity (CMC) living at home has been increasing; many have prior intensive care unit (ICU) stays, underscoring the need for early family training to support transition to home care.○Existing paediatric severity scores (e.g., Paediatric Index of Mortality 2/3 [PIM2/PIM3]) are mainly designed to predict mortality or length of stay and have not examined admission‐time predictors of home discharge or need for home medical care.
What this paper adds
○Using routinely available admission data, this study identifies independent predictors of home discharge: postoperative admission, lower heart rate at admission, absence of cardiopulmonary arrest immediately before ICU admission and no mechanical ventilation within the first hour.○It provides a practical threshold—heart rate 131 bpm at ICU admission—associated with the likelihood of home discharge.○In a pre‐specified secondary analysis, longer ICU length of stay was associated with the subsequent need for home medical care (cut‐off ≈12 days), informing discharge planning and early family education.

What is known about this topic
○The number of children with medical complexity (CMC) living at home has been increasing; many have prior intensive care unit (ICU) stays, underscoring the need for early family training to support transition to home care.○Existing paediatric severity scores (e.g., Paediatric Index of Mortality 2/3 [PIM2/PIM3]) are mainly designed to predict mortality or length of stay and have not examined admission‐time predictors of home discharge or need for home medical care.

The number of children with medical complexity (CMC) living at home has been increasing; many have prior intensive care unit (ICU) stays, underscoring the need for early family training to support transition to home care.

Existing paediatric severity scores (e.g., Paediatric Index of Mortality 2/3 [PIM2/PIM3]) are mainly designed to predict mortality or length of stay and have not examined admission‐time predictors of home discharge or need for home medical care.

What this paper adds
○Using routinely available admission data, this study identifies independent predictors of home discharge: postoperative admission, lower heart rate at admission, absence of cardiopulmonary arrest immediately before ICU admission and no mechanical ventilation within the first hour.○It provides a practical threshold—heart rate 131 bpm at ICU admission—associated with the likelihood of home discharge.○In a pre‐specified secondary analysis, longer ICU length of stay was associated with the subsequent need for home medical care (cut‐off ≈12 days), informing discharge planning and early family education.

Using routinely available admission data, this study identifies independent predictors of home discharge: postoperative admission, lower heart rate at admission, absence of cardiopulmonary arrest immediately before ICU admission and no mechanical ventilation within the first hour.

It provides a practical threshold—heart rate 131 bpm at ICU admission—associated with the likelihood of home discharge.

In a pre‐specified secondary analysis, longer ICU length of stay was associated with the subsequent need for home medical care (cut‐off ≈12 days), informing discharge planning and early family education.