Short‐term and long‐term mortality following pediatric intensive care

Volakli, Eleni; Σδούγκα, Μαρία; Drossou-Agakidou, V; Emporiadou, Maria; Reizoglou, Melpomeni; Giala, M.

doi:10.1111/j.1442-200x.2011.03545.x

Cited by 23 publications

(19 citation statements)

References 39 publications

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“…Mortality in paediatric intensive care unit over time according to country income category (World Bank data at time of study – https://data.worldbank.org/country). Data from Table 1 with best fit lines of correlation 1–3,16–74 . (), High income; (), middle income; (), low income; (), linear (middle income); (), linear (low income).…”

Section: Resultsmentioning

confidence: 99%

“…The CCS was a subjective score which may not have differentiated the sickest patients and has since been abandoned in favour of newer scoring systems. Most of the more recent papers report the PRISM or Paediatric Index of Mortality scores to enable comparison of different units 2,20,22,24–27,30–33,36–40,43,44,46–50,52,54–56,59,62,64,66,67,69–73 …”

Section: Resultsmentioning

confidence: 99%

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Outcomes following admission to paediatric intensive care: A systematic review

Procter

Morrow

Pienaar

et al. 2021

J Paediatrics Child Health

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Aim To describe the long‐term health outcomes of children admitted to a paediatric intensive care unit. Methods A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short‐, medium‐ and long‐term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. Results One hundred and eleven studies were included, most were conducted in high‐income countries and focussed on short‐term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high‐income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. Conclusions There is limited high‐level evidence for the long‐term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Outcomes following admission to paediatric intensive care: A systematic review

Procter

Morrow

Pienaar

et al. 2021

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…The Pediatric Risk of Mortality Score (PRISM III) was used for severity of illness [15]. A PRISM-III score of greater than 8 was employed as a cutpoint for illness severity [16, 17]. The billing diagnosis codes recorded for each patient were used to characterize an admission diagnosis of hypertension, the principal diagnosis for the hospitalization, and the presence and type of chronic conditions based on the organization of the ICD-9-CM [11].…”

Section: Methodsmentioning

confidence: 99%

Hypertension and Health Outcomes in the PICU

Ehrmann

Selewski

Troost

et al. 2014

Pediatric Critical Care Medicine

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Objectives Reports of the burden of hypertension in hospitalized children are emerging, but the prevalence and significance of this condition within the pediatric intensive care unit (PICU) are not well understood. The aims of this study were to validate a definition of hypertension in the PICU and assess the associations between hypertension and acute kidney injury (AKI), PICU length of stay (LOS), and mortality. Design and Setting Single center retrospective study using a database of PICU discharges between July 2011 and February 2013. Patients All children discharged from the PICU with LOS > 6 hours, aged 1 month through 17 years. Exclusions were traumatic brain injury, incident renal transplant, or hypotension. Measurements and Main Results Potential definitions of hypertension utilizing combinations of standardized cutoff percentiles, durations, initiation or dose escalation of antihypertensives, and/or billing diagnosis codes for hypertension were compared using receiver operator characteristic curves against a manual medical record review. Multivariable logistic and linear regression analyses were conducted using the selected definition of hypertension to assess its independent association with AKI and PICU LOS, respectively. A definition requiring 3 systolic and/or diastolic readings above standardized 99th percentiles plus 5 mmHg over 1 day was selected (area under the curve 0.91, sensitivity 94%, specificity 87%). Among the 1,215 patients in this analysis, the prevalence of hypertension was 25%. Hypertension was independently associated with AKI (OR 2.89, 95% CI 1.64–5.09, P<0.01) and increased PICU LOS (1.50 days, 95% CI 0.94–2.05, P<0.01) in multivariable analyses. Deaths were rare—0 in the normotension group and 3 (1%) in the hypertension group—but were statistically different (P=0.02). Conclusions Hypertension is common in the PICU and is associated with worse clinical outcomes. Future studies are needed to confirm these results.

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“…An example of the pediatric risk prediction scores, the Pediatric Risk of Mortality (PRISM III) [5], is a widely used scoring mechanism in pediatric ICU (PICU) [9] that has been validated in various settings as both an individual predictor and a significant predictor in a multivariate model in the United States and internationally [13][14][15][16][17][18][19][20][21]. A state-of-the-art scheme, PRISM III has an additive stepwise structure that relies on 17 physiological variables and 26 ranges.…”

Section: Pediatric Population Risk Scoresmentioning

confidence: 99%

Designing optimal mortality risk prediction scores that preserve clinical knowledge

Arzeno

Lawson

Duzinski

et al. 2015

Journal of Biomedical Informatics

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Many in-hospital mortality risk prediction scores dichotomize predictive variables to simplify the score calculation. However, hard thresholding in these additive stepwise scores of the form "add x points if variable v is above/below threshold t" may lead to critical failures. In this paper, we seek to develop risk prediction scores that preserve clinical knowledge embedded in features and structure of the existing additive stepwise scores while addressing limitations caused by variable dichotomization. To this end, we propose a novel score structure that relies on a transformation of predictive variables by means of nonlinear logistic functions facilitating smooth differentiation between critical and normal values of the variables. We develop an optimization framework for inferring parameters of the logistic functions for a given patient population via cyclic block coordinate descent. The parameters may readily be updated as the patient population and standards of care evolve. We tested the proposed methodology on two populations: (1) brain trauma patients admitted to the intensive care unit of the Dell Children's Medical Center of Central Texas between 2007 and 2012, and (2) adult ICU patient data from the MIMIC II database. The results are compared with those obtained by the widely used PRISM III and SOFA scores. The prediction power of a score is evaluated using area under ROC curve, Youden's index, and precision-recall balance in a cross-validation study. The results demonstrate that the new framework enables significant performance improvements over PRISM III and SOFA in terms of all three criteria.

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Short‐term and long‐term mortality following pediatric intensive care

Abstract: A 2 year follow-up period seems sufficient for a comprehensive mortality analysis of PICU patients. Severity of critical illness is the key factor of short-term mortality, whereas comorbidity is the major determinant of long-term mortality.

Cited by 23 publications

References 39 publications

Outcomes following admission to paediatric intensive care: A systematic review

Outcomes following admission to paediatric intensive care: A systematic review

Hypertension and Health Outcomes in the PICU

Designing optimal mortality risk prediction scores that preserve clinical knowledge

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