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Long-stay pediatric intensive care unit patients: outcome and resource utilization
M M Pollack1, J D Wilkinson, N L Glass
1Department of Anesthesiology (Division of Critical Care), Children's Hospital National Medical Center, Washington, DC 20010.
Insights
Pediatric intensive care unit (PICU) long-stay patients, though few, face higher mortality and severe disability. These critically ill children consume disproportionately high PICU resources, impacting overall care efficiency.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Resource Utilization
- Patient Outcomes
Background:
- Pediatric intensive care units (PICUs) manage critically ill children.
- Identifying patient subgroups with unique resource needs is crucial for optimizing care.
- Long-stay patients represent a distinct population within the PICU.
Purpose of the Study:
- To analyze the outcomes, resource utilization, and characteristics of pediatric intensive care unit patients with prolonged stays (over 13 days).
- To compare long-stay patients with short-stay patients regarding mortality, morbidity, and resource consumption.
Main Methods:
- Retrospective analysis of 647 consecutive pediatric intensive care unit admissions.
- Categorization into long-stay ( > 13 days) and short-stay patient groups.
- Comparison of demographic data, clinical condition, mortality rates, and resource utilization.
Main Results:
- Long-stay patients (7.1% of sample) experienced significantly higher PICU (17.4%) and hospital (23.9%) mortality rates compared to short-stay patients.
- Long-stay patients were younger, sicker, had more chronic diseases, and consumed approximately 50% of all PICU resources.
- One-year follow-up revealed 58% of surviving long-stay patients had died or were severely disabled.
Conclusions:
- Prolonged stays in the pediatric intensive care unit are associated with significantly worse patient outcomes, including increased mortality and severe disability.
- A small proportion of long-stay patients consumes a disproportionately large share of critical care resources.
- Effective resource allocation and targeted interventions are necessary for this vulnerable patient group.
Abstract:
Outcome, resource utilization, and health care characteristics of patients staying in a multidisciplinary pediatric intensive care unit (PICU) for more than 13 days (long-stay patients) were analyzed. Of 647 children admitted consecutively, 46 were long-stay patients. Compared with short-stay patients, long-stay patients were significantly younger and sicker and had a higher incidence of chronic disease. Most important, long-stay patients had significantly higher PICU mortality rates (17.4% v 7.3%, P less than .05) and hospital mortality rates (23.9% v 8.7%, P less than .01) than short-stay PICU patients. Although only 7.1% of the patient sample, long-stay patients consumed approximately 50% of all PICU resources. One-year follow-up on those long-stay patients surviving their hospitalization revealed that 58% had died or were severely disabled. Long-stay patients had relatively poor prognoses and consumed health care resources in excess of their numeric proportions.