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Pediatric Intensive Care in PICUs and Adult ICUs: A 2-Year Cohort Study in Finland
Outi M Peltoniemi1, Paula Rautiainen, Janne Kataja
11PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland. 2Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland. 3Department of Anesthesiology, Helsinki University Hospital, Helsinki, Finland. 4Department of Pediatrics, Turku University Hospital, Turku, Finland. 5Division of Intensive Care, Department of Anesthesiology, University of Oulu, Oulu, Finland. 6Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Faculty, University of Oulu, Oulu, Finland.
Insights
Children treated in Pediatric Intensive Care Units (PICUs) had lower mortality rates compared to those in adult ICUs. Factors like mechanical ventilation and emergency admission increased mortality risk in pediatric intensive care.
Area of Science:
- Pediatric critical care medicine
- Intensive care unit outcomes
- Epidemiology of pediatric critical illness
Background:
- The optimal setting for pediatric intensive care remains a subject of investigation.
- Understanding variations in mortality risk based on the type of intensive care unit (ICU) is crucial for improving outcomes in critically ill children.
- Previous studies have suggested potential differences in care and outcomes between pediatric and adult ICUs.
Purpose of the Study:
- To compare mortality rates between children treated in Pediatric Intensive Care Units (PICUs) and adult Intensive Care Units (ICUs).
- To identify factors associated with increased mortality risk in pediatric patients admitted to ICUs.
- To analyze the impact of ICU type (PICU vs. adult university hospital ICU vs. adult central hospital ICU) on pediatric patient outcomes.
Main Methods:
- A national multicenter cohort study was conducted in Finland.
- Data from 30 ICUs (26 national registries and 3 electronic management systems) were analyzed.
- Study included 4,876 children younger than 17 years, assessing admissions, length of stay, diagnoses, and mortality.
Main Results:
- Overall survival to discharge was high at 98.9%.
- Mechanical ventilation was required by 35% of patients in PICUs and adult university hospital ICUs, versus 19% in central hospital ICUs.
- Treatment in adult ICUs (both university and central hospitals) was associated with significantly higher odds of mortality compared to PICUs, even after adjustment for key variables.
Conclusions:
- Pediatric patients treated in dedicated PICUs experienced lower mortality rates.
- Mechanical ventilation, emergency admission, and readmission within 48 hours were linked to increased mortality risk.
- Specific diagnoses including cardiovascular, gastrointestinal, acute infections, hematologic/oncologic diseases, and nonsurgical trauma were also associated with higher mortality.
Objectives:
To investigate the association between the type of ICU and mortality for children treated at PICUs and adult ICUs.
Design:
This was a national multicenter cohort study. Data were collected from electronic critical care data management systems at 3 units and from national intensive care registries at 26 units.
Setting:
We assessed the incidence of admissions, length of stay at ICUs, main diagnoses, and mortality for children at ICUs. Units were categorized as PICUs or as adult ICUs located at university hospitals or at non-academic central hospitals.
Patients:
Children younger than 17 years of age treated at ICUs in Finland.
Interventions:
Not applicable.
Measurements And Main Results:
There were 4,876 admissions from 2009 to 2010, and 98.9% of patients survived until unit discharge. The mean length of stay was 3.0 ± 7.4 days; 1,395 patients (35%) required mechanical ventilation at PICUs versus 167 (35%) at adult university hospital ICUs versus 79 (19%) at central hospital ICUs (p < 0.001). The odds for mortality in univariate regression analysis were emergency admission (odds ratio, 3.99; 95% CI, 1.82-8.76), cardiovascular (odds ratio, 7.84; 95% CI, 3.49-22.88), gastrointestinal (odds ratio, 5.37; 95% CI, 1.45-19.88), acute infections (odds ratio, 2.83; 95% CI, 1.23-6.48), hematologic/oncologic disease (odds ratio, 10.32; 95% CI, 3.14-33.86), and nonsurgical trauma (odds ratio, 3.53; 95% CI, 1.19-10.41). Treatment at adult ICUs had higher odds of mortality compared with PICUs (university hospital: odds ratio, 3.93; 95% CI, 1.85-8.35 and central hospital: odds ratio, 3.91; 95% CI, 1.69-9.05), adjusted for readmission less than 48 hours after discharge, emergency admission, mechanical ventilation, and diagnostic group.
Conclusions:
Pediatric patients treated at PICUs showed lower mortality. Requirement of mechanical ventilation, emergency admission, and readmission less than 48 hours after discharge and cardiovascular, gastrointestinal, acute infections, hematologic/oncologic disease, and nonsurgical trauma were associated with higher risk of mortality.
