Pediatric Chronic Critical Illness: Validation, Prevalence, and Impact in a Children's Hospital
Rebekah K H Shappley1, Danielle L Noles1, Thomas Spentzas2
1Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.
Insights
Chronically critically ill pediatric patients occupy over a third of ICU beds, with stays five times longer than other patients. This highlights the need for standardized definitions and resource planning for this growing patient group.
Area of Science:
- Critical care medicine
- Pediatric intensive care
- Healthcare resource management
Background:
- Large populations of chronically critically ill patients strain critical care resources.
- Accurate census predictions require effective definition and tracking of this patient group.
Purpose of the Study:
- To define and quantify the prevalence and resource utilization of pediatric chronic critical illness (PCCI).
- To compare attending physicians' perceptions of PCCI with established criteria.
- To assess the impact of PCCI on intensive care unit (ICU) bed occupancy and patient length of stay.
Main Methods:
- Retrospective cohort analysis of patients admitted to pediatric and neonatal ICUs at a tertiary academic center.
- Sampling of demographics and resource utilization variables over 3 random days across 3 months.
- Comparison of attending perceptions with Shapiro's chronic critical care criteria.
Main Results:
- PCCI occurrence rate was 34%, with a prevalence of 44.5% and bed tolerance of 36.8%.
- Patients with PCCI had a median length of stay 5.1 times longer (46 days vs. 9 days).
- PCCI patients occupied 40.6% of PICU beds, 97.2% of intermediate care unit beds, 47.8% of cardiovascular ICU beds, and 33.9% of neonatal ICU beds.
Conclusions:
- PCCI patients represent a significant burden, occupying over one-third of ICU beds with substantially longer stays.
- Standardized definitions and national-level strategies are crucial for addressing the growing PCCI population.
- Consideration of PCCI is essential for current and future pandemic resource planning.
Objectives:
Large populations of chronically critically ill patients test the critical care system's resource utilization ability. Defining and tracking this group is necessary for census predictions.
Design:
Retrospective cohort analysis.
Settings:
Tertiary academic center in United States.
Patients:
Patients admitted to PICU or neonatal ICU.
Interventions:
None.
Measurements And Main Results:
Demographics and resource utilization variables were sampled in PICU, intermediate care unit, cardiovascular ICU, and neonatal ICU on 3 random days in 3 consecutive months. The attendings' perception of pediatric chronic critical illness was contrasted to Shapiro's definition of chronic critical care criteria. Each unit's active and maximal capacity census was computed: the occurrence rate of pediatric chronic critical illness was 34%, the prevalence was 44.5%, and the tolerance, or percentage pediatric chronic critical illness patients to all available beds, was 36.8%. The median length of stay for the nonpatients with pediatric critical care illness to patients with pediatric critical care illness was 9 versus 46 days (1/5.1). The attending's decision was 58 times more concordant with the criteria. Pediatric chronic critical illness bed occupancy was 40.6% in PICU, 97.2% in intermediate care unit, 47.8% in cardiovascular ICU, and 33.9% in neonatal ICU.
Conclusions:
Pediatric chronic critical illness patients occupied more than one third of the ICU beds and have five times longer stay. This mounting load needs to be uniformly defined, addressed at regional and national levels, and considered in the current pandemic planning.
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