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ICU-free days as a more sensitive primary outcome for clinical trials in critically ill pediatric patients

Hanjin Cho1, Barbara Wendelberger2, Marianne Gausche-Hill3,4,5,6

  • 1Department of Emergency Medicine College of Medicine Korea University Seoul Korea.

Journal of the American College of Emergency Physicians Open
|July 15, 2021
PubMed

Insights

Intensive care unit (ICU)-free days offer a sensitive measure for pediatric prehospital care outcomes, potentially surpassing survival or neurological status alone. This metric captures both survival and functional recovery, aiding emergency medical services research.

Area of Science:

  • Pediatric Emergency Medicine
  • Critical Care Research
  • Prehospital Care Outcomes

Background:

  • Assessing intensive care unit (ICU)-free days in pediatric prehospital care.
  • Evaluating ICU-free days as a sensitive outcome measure for emergency medical services (EMS) research.

Purpose of the Study:

  • To determine the association between ICU-free days and patient outcomes in pediatric prehospital care.
  • To compare the sensitivity of ICU-free days against traditional outcomes like survival and neurological status.

Main Methods:

  • Utilized data from a prior pediatric prehospital trial comparing bag-valve-mask-ventilation (BVM) and endotracheal intubation (ETI).
  • Defined ICU-free days as 30 minus ICU days (0-30 range), with death within 30 days assigned 0 ICU-free days.
  • Compared ICU-free days between BVM and ETI groups and correlated with survival and Pediatric Cerebral Performance Category (PCPC) scores.

Main Results:

  • No significant difference in median ICU-free days between BVM and ETI groups (0 vs. 0 days).
  • BVM group showed greater ICU-free days in subgroups: foreign body aspiration (30 vs. 0 days), child maltreatment (0 vs. 0 days), and respiratory arrest (25 vs. 7.5 days).
  • Higher ICU-free days correlated with increased survival to hospital discharge and favorable PCPC scores.

Conclusions:

  • ICU-free days appear to be a valuable clinical endpoint in pediatric prehospital resuscitation.
  • This metric may offer greater sensitivity than mortality or PCPC alone, encompassing aspects of both.
Abstract

Keywords:
critical careemergency medical servicespatient outcomesresearch methodologyresuscitation research

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