Chronic conditions among children admitted to U.S. pediatric intensive care units

Edwards, Jeffrey D.; Houtrow, Amy J.; Vasilevskis, Eduard E.; Rehm, Roberta S.; Markovitz, Barry P.; Graham, Robert J.; Dudley, R. Adams

doi:10.1097/ccm.0b013e31824e68cf

Cited by 274 publications

(154 citation statements)

References 20 publications

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“…These categories were then collapsed according to this clustering to create a less arduous ordinal age variable (0–2 mo, 2–6 mo, 6–12 mo, 1–18 yr, > 18 yr). CCCs were defined using Feudtner’s definition (23) and identified among diagnoses using a list of VPS codes developed elsewhere (24). An ordinal variable for CCC was created (no CCC, 1 CCC, ≥ 2 CCC).…”

Section: Methodsmentioning

confidence: 99%

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Edwards

Lucas

Stone

et al. 2013

Critical Care Medicine

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Objectives To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. Design Retrospective cohort analysis. Setting Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems. Patients One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011. Interventions None. Measurements and Main Results Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed. There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0–3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002). Conclusions Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.

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Section: Methodsmentioning

confidence: 99%

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Edwards

Lucas

Stone

et al. 2013

Critical Care Medicine

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“…The overwhelming majority of children admitted to a Pediatric Intensive Care Unit (PICU) in developed countries survive their critical illness and return home to their families, schools and communities (3). This decrease in mortality is unfortunately offset by the increase in morbidity amongst these children.…”

Section: Introductionmentioning

confidence: 99%

Functional Recovery Following Critical Illness in Children

Choong

Al-Harbi

Siu

et al. 2015

Pediatric Critical Care Medicine

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Objective To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children. Design Prospective pilot study. Setting Single center Pediatric Intensive Care Unit (PICU) at McMaster Children’s Hospital, Hamilton, Canada. Patients Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed-rest during the first 48 hours of PICU admission, and a minimum 48 hour PICU length of stay, were eligible. Patients transferred from a neonatal intensive care unit prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study were excluded. Measurements The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory (PEDI), and the Participation and Environment Measure for Children and Youth (PEM-CY). Main results Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, follow-up rates 93% at 3 months, and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status, and severity of illness. Conclusion Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory, and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multi-center study evaluating functional recovery in this population.

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“…(33) Children with chronic conditions are at risk of the longest ICU stays as well as repeat admissions. (34) Interdisciplinary palliative care services can help these patients maintain connections to school, friends, and activities to promote quality of life. (35)…”

Section: Picu Opportunities: Existing Needs and Potential Solutionsmentioning

confidence: 99%

Integrating Palliative Care Into the PICU

Boss

Nelson

Weissman

et al. 2014

Pediatric Critical Care Medicine

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Objective This review highlights the benefits that patients, families and clinicians can expect to realize when palliative care service is intentionally incorporated into the PICU, focusing on pain and symptom management, enhancing quality of life, communication and decision-making, length of stay and sites of care, and grief and bereavement. Data Sources MEDLINE Data Synthesis and Conclusions The American Academy of Pediatrics suggests that palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions.

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Chronic conditions among children admitted to U.S. pediatric intensive care units

Cited by 274 publications

References 20 publications

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Functional Recovery Following Critical Illness in Children

Integrating Palliative Care Into the PICU

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