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Characteristics and outcome of long-stay patients in a paediatric intensive care unit: a case-control study
PhA van der Heide1, M B F Hassing, R J B J Gemke
1Department of Paediatric Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands. p.a.vanderheide@amc.uva.nl
Insights
Long-stay patients in pediatric intensive care units (PICU) experience more complications but have similar outcomes and mortality rates compared to shorter-stay patients with the same diagnosis. This finding aids in understanding PICU patient trajectories.
Area of Science:
- Pediatric Critical Care Medicine
- Intensive Care Research
- Clinical Outcomes Analysis
Background:
- Long-stay patients in pediatric intensive care units (PICU) represent a distinct cohort requiring comprehensive evaluation.
- Understanding the differences and similarities between long-stay and other PICU patients is crucial for resource allocation and care planning.
Purpose of the Study:
- To compare baseline characteristics and outcomes of long-stay PICU patients (≥30 days) with matched controls.
- To identify specific factors contributing to prolonged PICU stays and their impact on patient trajectories.
Main Methods:
- Retrospective analysis of 19 long-stay PICU patients (aged 1-18 years) over 6 years.
- Matched each long-stay patient with a control patient admitted for the same diagnosis.
- Evaluated admission characteristics (age, comorbidities, risk scores) and long-term outcomes (survival, functional status up to 8.5 years post-admission).
Main Results:
- No significant differences in baseline characteristics were observed between long-stay and control groups.
- Long-stay patients experienced a higher mean number of complications (2.9 vs 1.2, p=0.02), with infections being a major contributor.
- Mortality rates (36.8% vs 26.7%) and functional status post-PICU discharge were similar between the groups.
Conclusions:
- Prolonged PICU stays are associated with increased complications but do not appear to negatively impact long-term mortality or functional outcomes compared to similarly diagnosed, shorter-stay patients.
- These findings suggest that while managing complications is vital, the underlying diagnosis and initial severity may be stronger predictors of long-term patient trajectories.
Aim:
To identify differences in baseline characteristics and outcome between long-stay and other patients admitted to a paediatric intensive care unit with the same diagnosis.
Methods:
Over a period of 6 y, data of paediatric intensive care unit patients with a length of stay of 30 or more days (long-stay patients) and aged 1 to 18y were retrospectively collected. Long-stay patients were matched with the next patient who was admitted to the paediatric intensive care unit with the same diagnosis. Evaluated characteristics on admission included: age, sex, presence of chronic morbidity, functional status, Pediatric Risk of Mortality score, presence of multiple organ system failure and complications during admission. Outcome (survival and functional status) was assessed 2.5 to 8.5 y after admission.
Results:
Of 19 long-stay patients identified, 15 could be matched with a control patient admitted with the same diagnosis. No significant difference in baseline characteristics was found between long-stay patients and the matched controls. The mean number of complications per long-stay patient was 2.9, compared to 1.2 per control patient (p = 0.02). Infection accounted for half of the complications. Mortality rate in long-stay patients was not higher than in the matched controls (36.8 vs 26.7%, p = 0.54). Paediatric intensive care unit stay did not change functional status in either long-stay patients or controls.
Conclusion:
Long-stay patients in the paediatric intensive care unit had more complications, but baseline characteristics, mortality and functional outcome were not different from a control group admitted with the same diagnosis.
