The critically ill child in the pediatric emergency department

A retrospective study of the charts of all critically ill patients visiting our pediatric emergency department over an 18-month period was conducted to determine age, diagnosis, time of presentation to the pediatric ED, Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) score, and eventual outcome. Eighty percent of critically ill patients were less than 6 years old. Of these patients, 35% had neurological problems, 23% had lower airway disease, and 15% had upper airway obstruction. Forty-one percent of children presented during the day shift, 33% during the evening shift, and 26% at night. One hundred fifteen patients survived to discharge from the intensive care unit; eight patients died. A statistically significant difference in retrospectively assigned PSI scores in nonsurvivors (18.1 +/- 6.5) compared with those in survivors (5.2 +/- 3.5) was observed. There was also a statistically significant difference in retrospectively assigned TISS scores in nonsurvivors (32.4 +/- 3.2) compared with those in survivors (13.5 +/- 2.1). Implications for physicians involved in the emergency care of critically ill children and for designs of pediatric advanced life support programs are outlined.