Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: A multi-institutional study

Fiser, Debra H.; Tilford, John M.; Roberson, Paula K.

doi:10.1097/00003246-200004000-00043

Cited by 174 publications

(138 citation statements)

References 14 publications

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“…2 However, in the study involving 11,104 patients, 576 patients improved, accounting for 5.1% of cases. 12 Oom also found similar results, reporting 6.4% of cases with negative delta-POPC. 4 In common with this study, the overwhelming majority of functional improvement cases were patients in postoperative and liver or kidney post-transplantation care, i.e., patients whose disabilities and/or diseases have been repaired and/or improved by means of surgical operations.…”

Section: Discussionsupporting

confidence: 59%

“…12 Volakli et al, in a study evaluating mortality and morbidity among patients 2 years after admission to an ICU, found that 25.8% of the patients had already presented alterations according to the PCPC scale and 40% by the POPC at the time of admission. 19 Cunha et al…”

Section: Discussionmentioning

confidence: 99%

“…The studies carried out by Fiser reported rates of cognitive alterations varying from de 15 to 42% and rates of functional alterations varying from 70 to 73%. 2,12 In the study undertaken by Oom, the presence of cognitive sequelae was observed in 32% of the children and of physical sequelae in 62% at discharge. improvement.…”

Section: Discussionmentioning

confidence: 99%

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Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

Alievi¹,

Carvalho²,

Trotta³

et al. 2007

J. Pediatr. (Rio J.)

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Objective: To assess the impact of admission to the pediatric intensive care unit (ICU) at the Hospital de Clínicas de Porto Alegre, RS, Brazil on children's cognitive and global performance.Methods: An observational, longitudinal study of a sequential sample of critically ill children. The following indicators were used: the Pediatric Index of Mortality (PIM), for severity and risk of death at admission, the Pediatric Cerebral Performance Category (PCPC), for cognitive morbidity and the Pediatric Overall Performance Category (POPC), for global morbidity, at admission and at discharge. Morbidity related to the ICU was measured according to the difference between classifications at discharge and at admission (delta scores). The Kruskal-Wallis test was applied.Results: A total of 443 patients were assessed, 54% of whom were male, with a median age of 12 months (IQ 4-45), and a median ICU stay of 4.24 days (IQ 2.4-8). The mortality rate was 6.3%. The median PIM score was 2.36% (IQ 1-7). On admission, 46% of the patients had some degree of cognitive morbidity and 66% had some degree of global morbidity. At discharge there was 60% cognitive morbidity and 86% global morbidity. The assessment of ICUrelated morbidity revealed that 25% of the patients had undergone cognitive changes while 41% had undergone global variations, at discharge compared with admission. Conclusions:Although affected by the elevated degree of morbidity at admission, the impact of the ICU stay was more significant in the global than in the cognitive domain. In the same manner, both risk of death at admission and length of stay had a significant effect on the morbidity of severely ill patients.J Pediatr (Rio J). 2007;83(6): 505-511:Outcome, critical care, pediatric cerebral performance category, pediatric overall performance category, morbidity.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

Alievi¹,

Carvalho²,

Trotta³

et al. 2007

J. Pediatr. (Rio J.)

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“…The retrospective nature of this study confined our data collection to what was recorded in the charts, and may contain unavoidable bias / residual confounders. It would have been preferable to have long-term outcome data such as 3, 6 and 12 month GOS or the Fiser scores (26,27) to assess the impact of hypotension. Unfortunately, there is currently no large or national pediatric database that contains serial hemodynamic data from the field through PICU discharge for a set of patients, making the present relatively small study valuable.…”

Section: Limitationsmentioning

confidence: 99%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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Objective-To examine the influence of definition and location (field, emergency department [ED] or Pediatric Intensive Care Unit [PICU]) of hypotension on outcome following severe pediatric Traumatic Brain Injury (TBI). Participants-93 children < 14 years of age with TBI following injury, head abbreviated injury score (AIS) ≥ 3, and PICU admission Glasgow Coma Sale (GCS) score < 9 formed the analytic sample. Data sources included the Harborview Trauma Registry and Hospital Records. Design-Retrospective Cohort study. Setting-HarborviewOutcome Measures-The relationship between hypotension and outcome was examined comparing two definitions of hypotension: 1) systolic blood pressure (SBP) < 5 th percentile for age and 2) SBP < 90 mmHg. Hospital discharge Glasgow Outcome score (GOS) < 4, or disposition of either death or discharge to a skilled nursing facility were considered poor outcomes. PICU and hospital length of stay (LOS) were also examined.Results-SBP < 5 th percentile for age was more highly associated with poor hospital discharge GOS (p = 0.001), poor disposition (p = 0.02), PICU LOS (RR 9.5; 95% CI 6.7-12.3) and hospital LOS (RR 18.8;) than SBP < 90mmHg. Hypotension occurring in either the field or ED, but not in the PICU, was associated with poor GOS (p = 0.008), poor disposition (p= 0.03) and hospital LOS (RR 18.7; 95% CI 13.1-24.2).Conclusions-Early hypotension, defined as SBP < 5 th percentile for age in the field and/or ED, was a better predictor of poor outcome than delayed hypotension or the use of SBP < 90 mmHg.

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“…As a consequence, patients with neurodevelopmental disabilities need to be treated in intensive care units more often than other patients. 13 In spite of the need for more serious treatment, the functional status of children with neurodevelopmental disabilities at their discharge from PICU was 4,10 Hence, in spite of differences between the units in populations of patients managed and available specialties, the POPC scale has shown to be a simple and accurate tool for assessment of outcome in intensive care units. It is, therefore, advisable to use it regularly as a means of evaluating health care quality in pediatric intensive care.…”

Section: -17mentioning

confidence: 99%

Desfecho funcional de crianças tratadas em unidade de terapia intensiva

Meštrović

Polić

Meštrović

et al. 2008

J. Pediatr. (Rio J.)

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Objective: Outcome of patients is determined not only by severity of illness index, but also by the impact of patients' preadmission comorbid status. Therefore, we aimed at evaluating the outcome of patients treated in a pediatric intensive care unit, with special focus on the group of children with chronic diseases.Methods: Data were obtained prospectively and outcome was assessed according to the Pediatric Overall Performance Category scale for 449 patients in a pediatric intensive care unit of the Split University Hospital. Functional performance was assessed as the preadmission score and the discharge score in patients with neurodevelopmental disabilities, patients with other chronic diseases, and those without chronic disease. Results:The discharge functional status was significantly dependent on the preadmission functional status and on predicted mortality. Children with neurodevelopmental disabilities had the significantly worse baseline score and the significantly smaller deterioration of functional morbidity at discharge compared to children with no chronic disease and children with other chronic diseases. Conclusions:The Pediatric Overall Performance Category scale has proved its applicability in a small intensive care unit, with a heterogeneous population of patients. It should therefore be considered for regular evaluation of health care quality, as a simple and accurate tool. As opposed to other patients, functional status of children with neurodevelopmental disabilities was markedly influenced by their comorbidity. Their preadmission status was worse than the status of other children, and hence could not significantly deteriorate at discharge. (Rio J). 2008;84(3):232-236: Child, critical care, chronic disease, health care quality, outcome assessment. J Pediatr

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Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: A multi-institutional study

Abstract: These data establish current relationships for the POPC and PCPC outcome scales based on multi-institutional data. The reported relationships can be used as reference values for evaluating clinical programs or for clinical outcomes research.

Cited by 174 publications

References 14 publications

Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Desfecho funcional de crianças tratadas em unidade de terapia intensiva

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