Pediatric admissions that include intensive care: a population-based study

Abstract

BackgroundPediatric admissions to intensive care outside children’s hospitals are generally excluded from registry-based studies. This study compares pediatric admission to specialist pediatric intensive care units (PICU) with pediatric admissions to intensive care units (ICU) in general hospitals in an Australian population.MethodsWe undertook a population-based record linkage cohort study utilizing longitudinally-linked hospital and death data for pediatric hospitalization from New South Wales, Australia, 2010–2013. The study population included all new pediatric, post-neonatal hospital admissions that included time in ICU (excluding neonatal ICU).ResultsOf 498,466 pediatric hospitalizations, 7525 (1.5%) included time in an intensive care unit – 93.7% to PICU and 6.3% to ICU in a general (non-PICU) hospital. Non-PICU admissions were of older children, in rural areas, with shorter stays in ICU, more likely admitted for acute conditions such as asthma, injury or diabetes, and less likely to have chronic conditions, receive continuous ventilatory support, blood transfusion, parenteral nutrition or die.ConclusionsA substantial proportion of children are admitted to ICUs in general hospitals. A comprehensive overview of pediatric ICU admissions includes these admissions and the context of the total hospitalization.

Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study

“…The mortality rate in this study was 2.1%, which is similar to the mortality rates in PICUs reported from other countries (2%–3%), and our findings are consistent with other reports 9–13. Neuromuscular and cardiovascular diseases were the most common causes of death in critically ill paediatric patients with chronic disease.…”

“…In more economically developed countries, the mortality rate in PICUs has decreased substantially from approximately 9% to 3% 8. According to a few international cohort studies, acute mortality rates vary from 2% to 3% during intensive care stays 9–17. The mortality rate for critically ill paediatric patients in Japan has been reported from a single centre, and multicentre studies have been limited primarily because no databases have been specifically designated for critically ill paediatric patients 18…”

The Relationship Between Estimated Median Household Income and Critical Care Length of Stay in Children With Diabetic Ketoacidosis

“…[8][9][10][11] Because many hospitalized children with DKA require PICU admission, understanding how modifiable patient risk factors influence short-term outcomes may ultimately decrease hospital utilization. 12,13 Approximately half of all children living in the United States live in low-income households. 14 It is known that socioeconomic factors are associated with poor glycemic control and higher incidence of DKA, but it is unclear if a patient's socioeconomic status influences short-term outcomes in the PICU.…”

“… 8 - 11 Because many hospitalized children with DKA require PICU admission, understanding how modifiable patient risk factors influence short-term outcomes may ultimately decrease hospital utilization. 12 , 13 …”

Interobserver Agreement on Clinical Judgment of Work of Breathing in Spontaneously Breathing Children in the Pediatric Intensive Care Unit

“…Worldwide, severe respiratory illness is among the most common reasons for children to be admitted to a pediatric intensive care unit (PICU). [1][2][3] Respiratory support for children in the PICU currently includes an increasing variety of noninvasive and invasive modalities. In the day-to-day choice among these respiratory support modalities during escalating and deescalating critical care, PICU clinicians use measures of gas exchange, such as blood gas analysis and pulse oximetry, cardiovascular monitoring, and assessment of the work of breathing (WOB).…”