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[Pediatric critical care in an adult ICU. Utility of the PIM index]
M Badia1, E Vicario, L García-Solanes
1Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
Insights
The Pediatric Index of Mortality (PIM) score effectively stratifies severity in critically ill children treated in adult ICUs. This highlights the need for specialized pediatric critical care resources and expertise in adult intensive care units.
Area of Science:
- Pediatric critical care medicine
- Intensive care unit management
- Health services research
Context:
- Critically ill children are sometimes treated in adult intensive care units (AICUs).
- The specific needs and outcomes of this patient population require careful evaluation.
- Assessing the utility of severity-scoring systems in this unique setting is crucial.
Purpose:
- To analyze the characteristics of pediatric patients treated in an AICU.
- To identify the procedures and techniques necessary for their care.
- To evaluate the effectiveness of the Pediatric Index of Mortality (PIM) score in stratifying patient severity.
Summary:
- A retrospective study analyzed 130 pediatric patients (1 month-14 years) in an AICU from 1997-2010.
- Common diagnoses included trauma and sepsis; key procedures were mechanical ventilation and central venous line placement.
- The PIM score demonstrated high accuracy (AUC=0.91) in predicting mortality, with higher scores in non-survivors.
Impact:
- The PIM score is a valuable tool for stratifying severity and identifying high-risk pediatric patients in AICUs.
- Effective critical care for children in AICUs necessitates appropriate resources and staff training in pediatric-specific procedures.
- Findings underscore the importance of tailored protocols for pediatric critical care within adult settings.
Objectives:
An analysis is made of the characteristics of patients younger than 14 years treated in an adult ICU (AICU), to determine the procedures and techniques required by such patients, and to evaluate the use of the Pediatric Index of Mortality (PIM) in stratifying severity.
Design:
A retrospective observational study was carried out.
Setting:
An AICU of a second level hospital.
Patients:
We studied 130 patients aged from 1 month to 14 years (average age 6.1±4 years) treated in the AICU from January 1997 to December 2010.
Variables Of Interest:
Clinical-demographic parameters, diagnosis, clinical procedures, PIM score, length of stay, transfer to pediatric ICU (PICU), and mortality. Classification by destination (AICU, PICU) and outcome (alive, dead). PIM and assessment of the diagnostic performance curve (ROC) for mortality.
Results:
The average age of the patients was 6.1±4 years. Most common diagnoses: trauma (26.9%) and sepsis (22.3%). Main procedures: mechanical ventilation (58.5%), central venous line (74.6%) and vasoactive drugs (20%). A total of 64.6% were transferred to PICU, and the overall mortality was 13%. Patients who stayed in the AICU were older (8.2±4 vs 5.5±4 years, p<0.001), had low morbidity, and their stay was short (44.5±38 hours). The PIM score was significantly higher in the patients who died (60±20 AICU, 38±30 PICU) than in those who survived (4±1 AICU, 9±1 PICU) (p<0.001). ROC curve with AUC=0.91 (95%CI: 0.85 to 0.98).
Conclusions:
The PIM score can stratify severity and identify patients at an increased risk of death. Critical child care in the AICU requires the presence of adequate materials and the continuous learning of procedures adapted to pediatric patients in order to ensure adequate care.
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