Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands

Abstract

Background High-risk patients in the pediatric intensive care unit (PICU) contribute substantially to PICU-mortality. Complex chronic conditions (CCCs) are associated with death. However, it is unknown whether CCCs also increase mortality in the high-risk PICU-patient. The objective of this study is to determine if CCCs or other factors are associated with mortality in this group. Methods Retrospective cohort study from a national PICU-database (2006–2012, n = 30,778). High-risk PICU-patients, defined as patients < 18 years with a predicted mortality risk > 30% according to either the recalibrated Pediatric Risk of Mortality-II (PRISM) or the Paediatric Index of Mortality 2 (PIM2), were included. Patients with a cardiac arrest before PICU-admission were excluded. Results In total, 492 high-risk PICU patients with mean predicted risk of 24.8% (SD 22.8%) according to recalibrated PIM2 and 40.0% (SD 23.8%) according to recalibrated PRISM were included of which 39.6% died. No association was found between CCCs and non-survival (odds ratio 0.99; 95% CI 0.62–1.59). Higher Glasgow coma scale at PICU admission was associated with lower mortality (odds ratio 0.91; 95% CI 0.87–0.96). Conclusions Complex chronic conditions are not associated with mortality in high-risk PICU patients. Electronic supplementary material The online version of this article (10.1186/s12887-019-1646-9) contains supplementary material, which is available to authorized users.

Children mortality in Pediatric Intensive Care Unit (PICU): An Overview

“…Variable length of ventilator use showed a significant length of stay of patients treated in intensive care and the risk of death in children 27 . The statement was in line with other research 28 showed the median on the third day of use of a mechanical ventilator showed an association between the outcomes of patients who died with a p-value <0.001. The risk posed by the duration of the use of a mechanical ventilator is based on the clinical care provided.…”

Simplified Pediatric Index of Mortality 3 Score by Explainable Machine Learning Algorithm

“…This would allow the risk stratification of these patients to occur immediately upon their arrival. Not unexpectedly, children with HR medical conditions admitted to the PICU (e.g., cardiac arrest prior to PICU admission) faced the highest ROM, along with those intubated, which is consistent with previous research ( 11 ). Furthermore, a PICU stay in recovery from a noncardiac surgery or admission with a LR diagnosis was associated with lower mortality risk, which is consistent with previous findings ( 1 ).…”

The magnitude of pediatric mortality and determinant factors in intensive care units in a low-resource country, Ethiopia: a systematic review and meta-analysis

“…The level of GCS of <8 has a factor in the mortality of PICU in our review. This finding is supported by studies conducted in Iran ( 30 ) and the Netherlands ( 31 ). The possible explanation for this factor was that decreased GCS level results in more critical patients and increased mortality.…”