Pediatric Intensive Care Outcomes

Abstract

Objective Investigate significant new morbidities associated with pediatric critical care. Design Randomly selected, prospective cohort Setting PICU patients from 8 Medical and Cardiac PICUs. Patients This was a randomly selected, prospective cohort of PICU patients from 8 Medical and Cardiac PICUs. Measurements and Main Results The main outcomes measures were hospital discharge functional status measured by Functional Status Scale (FSS) scores and new morbidity defined as an increase in the FSS of ≥ 3. Of the 5017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%) and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p<.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5% and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%) and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all FSS domains with the highest proportions involving respiratory, motor, and feeding dysfunction. Conclusions The incidence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared to historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.

Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

“…The patient populations and/or pathologies evaluated in the 66 studies included in the final review were: general PICU patients (n=15 studies) (9–23), seizures and/or status epilepticus (SE) (n=7) (24–30), traumatic brain injury (TBI) (n=17) (31–47), cardiac arrest (n=22) (48–69), and infectious diseases (n=5) (70–74). …”

“…Eligible studies included children <18 years of age admitted to a PICU, and evaluated neurofunctional outcomes using standardized outcome measure tool(s). Studies were excluded if they met any of the following criteria: (1) subjects were cared for in the neonatal or pediatric cardiac intensive care unit exclusively; (2) included an adult-only population or a mixed population with the inability to separate data for children; (3) case reports or case series with <10 subjects; (4) animal studies; (5) non-original data; or (6) studies published in language other than English.…”

“…New morbidity occurs in up to 4.8% PICU patients, with higher rates (7.3%) seen in children with critical neurologic conditions (3,20). In a retrospective analysis of 29,352 admissions to 24 PICUs submitting data to the Virtual PICU Performance System network, 3.4% and 10.3% of participants acquired global cognitive or functional disability, respectively, as measured by PCPC and Pediatric Overall Performance Category (POPC) at the time of hospital discharge (19).…”

“…Advances in science, technology and systems of care in emergency medicine and pediatric critical care medicine over the last several decades have led to significantly improved survival of children with critical illness (1–3). This trend of improved survival has been widely described in the overall pediatric intensive care unit (PICU) population (1) as well as in children with specific diagnoses, including sepsis (4), cardiac arrest (5,6), acute respiratory distress syndrome (ARDS) (7), and oncologic disorders (8).…”

“…This trend of improved survival has been widely described in the overall pediatric intensive care unit (PICU) population (1) as well as in children with specific diagnoses, including sepsis (4), cardiac arrest (5,6), acute respiratory distress syndrome (ARDS) (7), and oncologic disorders (8). However, increased survival has also translated to increased morbidity among survivors (2,9). Therefore, post-discharge morbidity, and specifically, new neurologic morbidity, has become a more relevant and meaningful outcome than mortality in the contemporary era of PICU care.…”