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Multi-institutional profile of adults admitted to pediatric intensive care units
Jeffrey D Edwards1, Amy J Houtrow, Eduard E Vasilevskis
1Division of Pediatric Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jde2134@columbia.edu
Insights
Adults admitted to pediatric intensive care units (PICUs) represent a small but high-risk patient group. These findings highlight the need for specialized protocols in PICUs caring for adult patients with complex chronic conditions.
Area of Science:
- Critical Care Medicine
- Pediatric Health
- Adult Congenital Heart Disease
Background:
- Increasing survival of individuals with childhood-onset chronic illnesses into adulthood.
- Many adults with chronic conditions utilize pediatric healthcare facilities for inpatient care.
- Limited data exists on the prevalence and characteristics of adult patients in pediatric intensive care units (PICUs).
Purpose of the Study:
- To determine the proportion of adult patients admitted to PICUs.
- To characterize the clinical profiles of adult PICU patients.
- To compare outcomes of adult PICU patients with those of older adolescents.
Main Methods:
- A one-year cross-sectional analysis of data from US PICUs participating in the Virtual Pediatric Intensive Care Unit Systems.
- Inclusion of all PICU patients aged 15 years and older admitted in 2008.
- Comparison of clinical characteristics and outcomes between adult and adolescent patients, utilizing mixed-effects logistic regression to assess mortality risk.
Main Results:
- Out of 67,629 admissions across 70 PICUs, 2.7% were adults (≥19 years) and 13.5% were older adolescents (15-18 years).
- Adult PICU admissions varied significantly by institution (0%-9.2%).
- Increasing age correlated with higher rates of complex chronic conditions and planned/perioperative admissions, while trauma admissions decreased. Adults aged 21-29 and ≥30 years showed significantly increased odds of PICU mortality compared to adolescents.
Conclusions:
- Adults comprise a small but high-risk patient population in some PICUs.
- The findings suggest a need for PICUs to develop specific care plans and protocols for adult patients.
- This research underscores the evolving demographic within PICUs and the associated critical care needs.
Importance:
Growing numbers of persons with childhood-onset chronic illnesses are surviving to adulthood. Many use pediatric hospitals for their inpatient needs. To our knowledge, the prevalence and characteristics of adult pediatric intensive care unit patients have not been reported.
Objectives:
To estimate the proportion of adults admitted to pediatric intensive care units (PICUs), characterize them, and compare them with older adolescents.
Design:
One-year cross-sectional analysis.
Setting:
Pediatric intensive care units in the United States that participated in the Virtual Pediatric Intensive Care Unit Systems.
Participants:
Pediatric intensive care unit patients 15 years or older admitted in 2008.
Main Outcome Measures:
We compared adults with adolescents across clinical characteristics and outcomes. Mixed-effects logistic regression was used to estimate the independent association of age with PICU mortality.
Results:
Seventy PICUs had 67 629 admissions; 1954 admissions (2.7%) were patients 19 years or older; and 9105 admissions (13.5%) were patients aged 15 to 18 years. The proportion of adults (≥19 years) varied considerably by PICU (range, 0%-9.2%). As age increased, the proportion of patients who had a complex chronic condition and planned or perioperative admissions increased; the proportion of trauma-related admissions decreased. Patients aged 21 to 29 years had a 2 times (95% CI, 1.3-3.2; P = .004) greater odds of PICU mortality compared with adolescent patients, after adjusting for Paediatric Index of Mortality score, sex, trauma, and having a complex chronic condition. Being 30 years or older was associated with a 3.5 (95% CI, 1.3-9.7; P = .01) greater odds of mortality.
Conclusions And Relevance:
In this multi-institutional study, adults constituted a small but high-risk proportion of patients in some PICUs, suggesting that these PICUs should have plans and protocols specifically focused on this group.
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