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Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC
Kohei Tsukahara1, Hiromichi Naitou1, Takashi Yorifuji2
1Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Insights
Centralizing pediatric intensive care units (PICUs) in Japan improves outcomes for children with endogenous illnesses. Outcomes for exogenous illnesses were similar between PICUs and general ICUs, warranting further study on centralization.
Area of Science:
- Pediatric critical care medicine
- Healthcare systems research
Background:
- Centralizing treatment for critically ill children is recognized as important but challenging in Japan.
- Pediatric intensive care units (PICUs) and general intensive care units (ICUs) are common models for pediatric critical care.
Purpose of the Study:
- To compare illness severity, trauma, and mortality in children admitted to PICUs versus general ICUs in Japan.
- To analyze differences in outcomes based on endogenous and exogenous illness types between PICUs and general ICUs.
Main Methods:
- Retrospective analysis of 1,333 pediatric patients admitted to PICUs (n=1,143) and general ICUs (n=190).
- Comparison of Pediatric Cerebral Performance Category (PCPC) scores at discharge, mortality, and neurological outcomes.
- Stratification of analysis by endogenous versus exogenous illness settings.
Main Results:
- PICU admission was associated with significantly better PCPC scores (adjusted OR: 0.45) and lower rates of death or unfavorable neurological outcomes (adjusted OR: 0.29).
- For endogenous illnesses, PICUs showed lower PCPC deterioration and overall sequelae/death rates.
- Outcomes for exogenous illnesses did not significantly differ between PICUs and general ICUs.
Conclusions:
- PICUs demonstrate superior outcomes for pediatric patients with endogenous critical illnesses compared to general ICUs.
- The benefits of centralization may be more pronounced for endogenous conditions, while outcomes for exogenous conditions are comparable.
- Further research is needed to determine the necessity and optimal strategy for centralizing pediatric critical care services in Japan.
Abstract:
The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.
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