Variation in pediatric intensive care therapies and outcomes by race, gender, and insurance status*

Lopez, Adriana; Tilford, John M.; Anand, K.J.S.; Jo, Chan‐Hee; Green, Jerril W.; Aitken, Mary E.; Fiser, Debra H.

doi:10.1097/01.pcc.0000192319.55850.81

Cited by 61 publications

(60 citation statements)

References 38 publications

(37 reference statements)

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“…The most severe incidents were respiratory in nature, which might be due to the fact that accidental extubations were included in this group and were all considered of major severity. We had 0.74 unplanned extubations per 100 ventilator days, less than other authors have described [13,14,22] and similar to rates reported by Ligi and co-workers [12]; however, the case mix should be considered when comparing rates of accidental extubations. Similar to the study of Veldman et al [26], only two of the ten patients had to be re-intubated.…”

Section: Discussionsupporting

confidence: 79%

“…Other authors found a higher mortality rate of boys in Table 3 Logistic regression analysis of probable explanatory factors for whether a patient is affected by critical incident(s) or not a non-premature paediatric cardiac ICU population treated with ECMO [14]. On the contrary, Lopez et al did not find differences in standardized mortality ratio related to gender in their multicenter PICU study [13]. It is not clear whether the longer length of stay we found in the CI group is caused by CIs or whether the risk to experience a CI is higher due to the patients' longer stay in circumstances where invasive procedures, bustle and a high turnover of patients are very common [12].…”

Section: Discussionmentioning

confidence: 91%

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Critical incidents in paediatric critical care: who is at risk?

2010

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We evaluated the characteristics of children for whom critical incidents (CIs) were reported by performing prospective collection of patient data and retrospective review of reported CIs in a multidisciplinary neonatal-paediatric intensive care unit of a tertiary care university children's hospital. A period of 1 year was analysed (January to December 2007; 1,251 admissions). CIs comprised adverse events (actual patient injury), as well as near-misses. The report form of critical incidents was web-based and reporting was voluntary, anonymous and non-punitive. The severity of all CIs was divided into minor, moderate and major. Patients with and without CIs were compared regarding the following characteristics: Paediatric Index of Mortality (PIM2), duration of mechanical ventilation, length of stay in the intensive care, admission mode (surgery, cardiopulmonary bypass, cardiac/non-cardiac unit), age and sex. There were 360 CI reports (83 per 1,000 patient days; 13% major, 26% moderate, 61% minor severity). Of these, 310 CIs could be assigned to 198 specific patients. In the univariate analysis, patient-related risk factors for CIs were higher PIM2 score (p < 0.0001), increased length of stay (p < 0.0001), mechanical ventilation (p < 0.0001), increased ventilator days (p < 0.0001), male gender (p = 0.022) and young age (p < 0.0001). Using a logistic regression model, mechanical ventilation (p < 0.0001), male gender (p = 0.034) and length of stay (p < 0.0001) continued to be associated with the occurrence of CIs. Conclusion CIs often occur in paediatric intensive care. Among the patient-related factors, male gender, mechanical ventilation, and length of stay are independently associated with CIs. Already known at admission to intensive care are male gender and, usually, requirement for mechanical ventilation. Improved knowledge of the risk factors for CIs could help to minimize their frequency and thus improve quality of care.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 91%

Critical incidents in paediatric critical care: who is at risk?

2010

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“…Also, this finding is in agreement with the study of Lopez [1] who stateed that the majority of patients admitted in the PICU for five years were males (57.5%). At the end of their study, they demonstrate that there is no difference between both genders regarding outcomes.…”

Section: Results:-supporting

confidence: 82%

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Elghaiaty¹,

Sobeih²,

Bayoumy³

2018

IJAR

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Background: little is known about the exact causes of death, and the impact of general risk factors that may complicate the course of critically ill patients. Scoring systems for use in ICUS allow an assessment. Aim of the study: To evaluate the usefulness of PIM2 score in predicting the outcome (mortality rate) in PICU in Benha university hospitals. Methods: This prospective study was conducted on 113 patients admitted to PICU in Benha University Hospitals in pediatric department over a period of six months. All patients aged more than one month up to less than sixteen years old. Pediatric index of mortality 2 was scored for all patients within an hour of admission to PICU using a structured data collection form and then compared with outcome which recorded as death or discharge. Results: Data were collected prospectively as a cohort study upon 11 children admitted to PICU in Benha University hospitals during a six months period. The outcome of the 113 patients included in the study was 77 survivors and 36 non-survivors. Observed death rate was (31.9%) and the predicted mortality rate by PIM2 score was 38.1%. So, the standardized mortality ratio was 0.84 signifying overestimation of mortality rate and/or good performance of our unit. PIM2 discriminated between death and survival well with area under the ROC curve was 0.73 and cutoff value at (-2.99) which is a good discrimination and calibrated well (p = 0.88 in non survivors and 0.83 in survivors). Conclusion: PIM2 applied in our PICU was significantly correlated to mortalities as PICU outcome and showed adequate discriminatory function and well calibrated for the case mix of patients in PICU of Benha University hospitals. So, it can be used as a good predictor of mortality in PICUS.

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“…Iantorno et al [8] reported no sex-or race-based treatment disparities in the use of pulmonary artery catheterization in the adult ICU population, and Erickson et al [50] did not find any disparities in hospital mortality or ICU length of stay in adult ICU patients. In the pediatric population, both Lopez et al [9] and Epstein et al [9,10] found no difference in pediatric ICU mortality based on race/ethnicity but did find that severity of illness at the time of ICU admission was higher for the uninsured and government-insured patients. Although convincing evidence for disparities in ICU health care based on race/ethnicity is lacking, most inequities in health care in the ICU seem to be based on socioeconomic status and health insurance [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 95%