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Published on: April 7, 2023
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Prediction of Pediatric Critical Care Resource Utilization for Disaster Triage
Elizabeth Y Killien1,2, Brianna Mills2, Nicole A Errett3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Summary
Pediatric illness severity scores can predict intensive care needs. A model using the 12-hour Pediatric Logistic Organ Dysfunction score accurately estimated resource use, aiding disaster triage.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Disaster preparedness
Background:
- Pediatric disaster triage protocols lack validation data.
- The 2011 Pediatric Emergency Mass Critical Care Task Force recommended incorporating critical care duration into resource allocation.
- Existing pediatric illness severity scores may predict critical care resource utilization.
Purpose of the Study:
- To determine if current pediatric illness severity scores can predict the duration of critical care resource use.
- To develop and validate predictive models for pediatric intensive care unit (PICU) resource allocation during mass critical care events.
Main Methods:
- Retrospective cohort study of 3,206 PICU patients admitted to Seattle Children's Hospital from 2016-2018.
- Logistic and linear regression models were developed using two-thirds of the cohort to predict the need for and duration of PICU resources.
- Models utilized Pediatric Risk of Mortality-III, Pediatric Index of Mortality-3, and serial Pediatric Logistic Organ Dysfunction-2 scores, validated on the remaining one-third of the cohort.
Main Results:
- The 12-hour Pediatric Logistic Organ Dysfunction score demonstrated higher predictive accuracy than Pediatric Risk of Mortality or Pediatric Index of Mortality scores.
- A model incorporating the 12-hour Pediatric Logistic Organ Dysfunction score, age, and other clinical factors achieved an area under the receiver operating characteristic curve of 0.8831 for predicting the need for any PICU resource and 0.9157 for mechanical ventilation.
- Models accurately predicted greater than or equal to 24 hours of any resource use for 78.9% of patients and mechanical ventilation for 83.1%.
Conclusions:
- A model incorporating the 12-hour Pediatric Logistic Organ Dysfunction score effectively estimates the duration of PICU resource needs, particularly mechanical ventilation.
- Integrating likelihood for survival and critical care resource requirements into pediatric disaster triage algorithms can reduce subjectivity in resource allocation.
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