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Pediatric intensive care outcomes: development of new morbidities during pediatric critical care
Murray M Pollack1, Richard Holubkov, Tomohiko Funai
11Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 6Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 9Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD.
Insights
Pediatric critical care may be trading improved survival for increased new morbidities, affecting nearly all patient types and functional aspects. This study found a 4.8% new morbidity rate, double the mortality rate, in pediatric intensive care unit patients.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Outcomes Research
- Patient Morbidity Studies
Background:
- Pediatric critical care aims to improve survival rates for critically ill children.
- Assessing new morbidities is crucial for understanding the comprehensive impact of pediatric intensive care unit (PICU) interventions.
- Historically, focus has been on mortality, with less emphasis on long-term functional outcomes and new morbidities.
Purpose of the Study:
- To investigate the incidence and characteristics of significant new morbidities in pediatric critical care.
- To evaluate the functional status of pediatric patients upon discharge from PICU and hospital.
- To compare morbidity and mortality rates across different PICU sites.
Main Methods:
- A prospective cohort study of 5,017 patients admitted to eight medical and cardiac pediatric intensive care units.
- Functional status was measured using the Functional Status Scale (FSS) at PICU and hospital discharge.
- New morbidity was defined as an increase in FSS score of ≥3 points.
Main Results:
- The overall incidence of new morbidity was 4.8% (242 patients), with mortality rates of 2.0% (PICU) and 2.4% (hospital).
- Morbidity and mortality rates varied significantly between participating sites (p < 0.001).
- New morbidities were highest in neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). Respiratory, motor, and feeding dysfunctions were most affected.
Conclusions:
- New morbidity occurred in 4.8% of pediatric critical care patients, a rate twice that of mortality.
- These new morbidities affected all patient types and functional domains, suggesting a potential shift from reduced mortality to increased morbidity.
- Pediatric critical care may be achieving improved survival at the cost of higher rates of new functional impairments.
Objective:
To investigate significant new morbidities associated with pediatric critical care.
Design:
Randomly selected, prospective cohort.
Setting:
PICU patients from eight medical and cardiac PICUs.
Patients:
This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.
Measurements And Main Results:
The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 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 < 0.001) 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 Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.
Conclusions:
The prevalence 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 with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.
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