Background and Aims:Studies carried out in different countries have shown that source of patient admission in Intensive Care Units (ICUs) is associated to death. Patients admitted from wards show a greater ICU mortality. The aim of the present study was to investigate the association between admission source and outcome in a Pediatric Intensive Care Unit (PICU).Materials and Methods:We studied all PICU admissions that took place between January 2002 and December 2005 in a tertiary hospital in Brazil. The major outcome studied was death while in the PICU. The independent variable analyzed was admission source, defined either as pediatric emergency room (PER), wards, operating room (OR) of the same hospital or other sources.Results:A total of 1823 admissions were studied. The overall expected mortality based on the Pediatric Index of Mortality 2 was 6.5% and the observed mortality was 10.3%. In adjusted analysis, the mortality was doubled in patients admitted from wards when compared with the PER patients.Conclusions:Observed mortality rates were higher in patients admitted from wards within the same hospital, even after adjustment.

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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.