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Association between Down syndrome and mortality in young children with critical illness: a propensity-matched
Punkaj Gupta1, Mallikarjuna Rettiganti2
1Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Critically ill children with Down syndrome (DS) do not have higher mortality. However, their mortality risk increases with longer hospital stays, indicating a need for careful management.
Area of Science:
- Pediatric critical care medicine
- Genetics and developmental disorders
- Epidemiology
Background:
- Down syndrome (DS) is a genetic disorder associated with various health complications.
- The impact of DS on outcomes for critically ill children is not well-established.
- Understanding mortality risk in this population is crucial for clinical management.
Purpose of the Study:
- To evaluate the outcomes, specifically mortality, in critically ill young children with Down syndrome.
- To compare mortality rates between children with and without Down syndrome using a national database.
- To identify factors influencing mortality risk in critically ill children with Down syndrome.
Main Methods:
- Utilized data from the Pediatric Health Information System (PHIS) database (2004-2013).
- Included patients aged one day to 24 months admitted to an intensive care unit.
- Employed propensity score matching to create comparable cohorts of children with and without Down syndrome.
Main Results:
- A total of 293,697 patients were analyzed, with 12,282 (4%) having Down syndrome.
- After propensity score matching (10,477 pairs), mortality rates were similar between groups (OR, 0.96; 95% CI, 0.87-1.07).
- Mortality risk for children with Down syndrome increased with longer hospital length of stay (LOS).
Conclusions:
- Down syndrome itself did not significantly increase mortality risk in critically ill children.
- A time-dependent differential mortality risk was observed, with increasing risk linked to prolonged hospital LOS.
- These findings highlight the importance of managing hospital length of stay for critically ill children with Down syndrome.
Aim:
To evaluate the outcomes among critically ill young children with Down syndrome using propensity score matching from a national database.
Methods:
Patients in the age group from one day through 24 months admitted to an intensive care unit during their hospital stay at a Pediatric Health Information System (PHIS)-participating hospital (2004-2013) were included.
Results:
Of the 293,697 patients who qualified for inclusion, 12,282 (4%) were classified in the Down syndrome group. Using propensity score matching, 10,477 patients with Down syndrome were matched one to one to patients without Down syndrome. Prior to matching, the mortality was significantly lower among the patients with Down syndrome (with vs. without Down syndrome, odds ratio (OR), 0.74; 95% confidence interval (CI), 0.69-0.79; p < 0.001). After matching, the mortality was similar in both groups (OR, 0.96; 95% CI, 0.87-1.07; p = 0.51). The mortality risk increased among the Down syndrome patients with increasing hospital length of stay (LOS).
Conclusion:
In this large, contemporary cohort, Down syndrome did not confer a significantly higher mortality risk among children with critical illness. However, children with Down syndrome followed a time-dependent, differential mortality risk with increased risk noted in relation to increasing hospital LOS.
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