Prevalence of Children With Complex Chronic Conditions in PICUs of Argentina: A Prospective Multicenter Study
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María Del P Arias López1, Ariel L Fernández2, Karina Fiquepron3
1PICU, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Insights
Nearly half of pediatric intensive care unit (PICU) admissions in Argentina involved children with complex chronic conditions. These children faced higher mortality and increased resource utilization compared to healthy peers.
Area of Science:
- Pediatric critical care medicine
- Epidemiology of chronic childhood diseases
Background:
- Complex chronic conditions (CCC) significantly impact pediatric healthcare systems.
- Understanding CCC prevalence in Pediatric Intensive Care Units (PICUs) is crucial for resource allocation and care planning.
Purpose of the Study:
- To determine the prevalence of children with CCC in Argentinian PICUs.
- To compare the demographic profile, clinical course, and outcomes of children with CCC against previously healthy children.
Main Methods:
- A prospective, observational, multicenter study was conducted across 19 PICUs in Argentina.
- Data were collected on 3,483 PICU admissions between March 2015 and February 2016.
- Children with CCC were compared to previously healthy children regarding mortality, length of stay, and device utilization.
Main Results:
- The prevalence of CCC was 48.06%, with cardiovascular, neuromuscular, and malignant diseases being predominant.
- Children with CCC exhibited significantly higher mortality (OR 2.74) and prolonged PICU stays (OR 1.44).
- Increased utilization of mechanical ventilation (OR 1.35), central venous catheters (OR 1.24), and arterial monitoring (OR 1.33) was observed in children with CCC.
Conclusions:
- A high prevalence of children with CCC was found in Argentinian PICUs.
- These patients experienced worse outcomes and higher resource consumption than their healthy counterparts.
- Findings underscore the need for strategic planning to manage the impact of CCC on PICU services.
Objectives:
To determine the prevalence of children with complex chronic conditions in PICUs in Argentina. To describe the demographic profile, clinical course and outcomes in PICU of children with complex chronic condition in comparison to previously healthy children.
Design:
Prospective, observational multicenter study.
Setting:
Nineteen PICUs located in Argentina belonging to public and private institutions.
Patients:
All children admitted to the participating PICUs between March 1, 2015, and February 28, 2016.
Interventions:
None.
Measurement And Main Results:
We analyzed 3,483 PICU admissions. The prevalence of complex chronic condition was 48.06% (95% CI, 46.39-49.72). Cardiovascular complex chronic condition was predominant (22.24% [421/1,893]), followed by neuromuscular complex chronic condition (18.75% [355/1,893]) and malignant disease 17.7% (335/1,893). Technologic dependence was present in 22.22% of the patients (372 of 1,674). Predominant admission diagnosis was postoperative (36.6%) and respiratory disease (28.32%). Children with complex chronic condition had higher mortality than previously healthy patients (odds ratio, 2.74; 95% CI, 2.01-3.73). The risk of prolonged stay (≥ 26 d) was also higher (odds ratio, 1.44; 95% CI, 1.10-1.89). Rate utilization of the following devices was higher in patients with complex chronic condition: mechanical ventilation (odds ratio, 1.35; 95% CI, 1.12-1.63), central venous catheter (odds ratio, 1.24; 95% CI, 1.04-1.48), and arterial monitoring (odds ratio, 1.33; 95% CI, 1.09-1.63).
Conclusions:
We observed a high prevalence of patients with complex chronic condition in this sample of argentine PICUs. These patients presented higher mortality and resource use than previously healthy children. This information is valuable to understand the impact that patients with complex chronic condition have on PICU performance and enables proper planning of care.
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