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Epidemiology of Pediatric Critical Illness in a Population-Based Birth Cohort in Olmsted County, MN
Sheri S Crow1, Chaitanya Undavalli, David O Warner
11Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Department of Health Services Research, Mayo Clinic College of Medicine, Rochester, MN. 2Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN. 3Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN. 4Department of Epidemiology and Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN. 5Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN. 6Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN. 7Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN. 8Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA.
Insights
This study reports the first U.S. population-based analysis of pediatric critical illness incidence and presentation in a birth cohort. Findings reveal changing healthcare needs as children develop, with highest intensive care unit (ICU) admission rates in the first year of life.
Area of Science:
- Pediatric critical care epidemiology
- Population health research
- Longitudinal cohort studies
Background:
- Current pediatric critical illness research often relies on diverse inpatient cohorts.
- There is a lack of studies examining the full spectrum of critical illness development within a community setting in the U.S.
- Understanding community-based pediatric critical illness is crucial for public health planning.
Purpose of the Study:
- To conduct the first epidemiologic report on the incidence and presentation of pediatric critical illness.
- To analyze data from a U.S. population-based birth cohort.
- To characterize critical illness across the developmental spectrum in children.
Main Methods:
- Retrospective cohort study design.
- Utilized a geographically defined community (Olmsted, MN) with linked medical records across all health systems.
- Included a birth cohort of 9,441 children born between 2003-2007.
Main Results:
- Identified 824 intensive care unit (ICU) admissions among 577 children over 61,770 person-years.
- Incidence of first-time ICU admission was 9.3 per 1,000 person-years, highest in the first year of life.
- Respiratory problems were common; post-infancy admissions often involved comorbidities, with mortality concentrated in neonates.
Conclusions:
- This study provides the first characterization of critical illness in a U.S. population-based birth cohort.
- Results highlight evolving incidence, presentation, and healthcare demands of critical illness as children age.
- Findings underscore the importance of developmental stage in understanding pediatric critical care needs.
Objectives:
Investigations of pediatric critical illness typically focus on inpatient cohorts drawn from wide referral areas and diverse healthcare systems. Cohorts amenable to investigating the full spectrum of critical illness as it develops within a community have yet to be studied in the United States. Our objective was to provide the first epidemiologic report of the incidence and presentation of pediatric critical illness within a U.S. population-based birth cohort.
Design:
Retrospective cohort study.
Setting:
A geographically defined community (Olmsted, MN) with medical record linkage across all health systems. All ICU services are provided within a single children's hospital.
Patients:
A birth cohort of children (n =9,441) born 2003-2007 in Olmsted County, MN.
Measurements And Main Results:
During the study period, there were a total of 15,277 ICU admissions to Mayo Clinic Children's Hospital. A total of 577 birth cohort children accounted for 824 of these admissions during the 61,770 person-years of follow-up accumulated. Incidence of first-time ICU admission was 9.3 admits per 1,000 person-years. Admission rates were highest in the first year of life and then declined steadily. Respiratory problems were among the most common reasons for admission at any age and diagnoses reflect changes in health risk factors as children grow and develop over time. After 1 year old, a majority of children admitted have preexisting chronic comorbidities and/or prior ICU stays. In-hospital mortality occurred exclusively in children admitted prior to 5 days of age (n = 4). Seven children died after hospital discharge.
Conclusions:
This is the first report characterizing critical illness within a population-based birth cohort of U.S. children. The results demonstrate the changing incidence, presentation, and healthcare requirements associated with critical illness across the developmental spectrum as a population of children ages.
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