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Risks for death after admission to pediatric intensive care (PICU)-A comparison with the general population

Tova Hannegård Hamrin1,2, Staffan Eksborg1,3

  • 1Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden.

Plos One
|October 7, 2022
PubMed

Insights

Children admitted to a Pediatric Intensive Care Unit (PICU) face significantly higher mortality rates compared to the general population, with elevated risks persisting for years post-discharge. This excess mortality is particularly pronounced in readmitted patients and those with specific diagnoses.

Area of Science:

  • Pediatric Intensive Care
  • Mortality Studies
  • Public Health

Background:

  • Pediatric Intensive Care Units (PICUs) provide critical care for critically ill children.
  • Understanding long-term mortality risk after PICU admission is crucial for improving patient outcomes.
  • Previous studies have not fully quantified excess mortality in this population compared to the general population.

Purpose of the Study:

  • To quantify excess mortality in children following Pediatric Intensive Care Unit (PICU) admission.
  • To compare mortality rates of PICU patients with the age- and sex-matched general Swedish population.
  • To analyze mortality trends based on age, risk stratification, and readmission status.

Main Methods:

  • Retrospective cohort study utilizing Swedish national registers (hospital, population) and Statistics Sweden data.
  • Inclusion of 6,487 admissions (4,682 patients) to a tertiary PICU between 2008-2016.
  • Calculation of Standardized Mortality Ratios (SMRs) using the general Swedish population as a reference, with analysis stratified by age and Predicted Death Rate (PDR).

Main Results:

  • Overall SMR for PICU admissions was 49.8, indicating significantly higher mortality than the general population.
  • Readmitted patients had a higher SMR (108.0) compared to those with a single admission (35.2).
  • Excess mortality persisted for up to four years post-PICU discharge, with SMRs declining but remaining elevated.

Conclusions:

  • Children admitted to the PICU experience substantially elevated mortality risks compared to their peers in the general population.
  • Mortality risk is particularly high for readmitted children, especially those with oncology/hematology or neurologic conditions.
  • The study highlights the need for continued monitoring and support for children post-PICU discharge.
Abstract

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