Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study

Area of Science:

• Pediatric Critical Care Medicine
• Public Health Surveillance
• Health Services Research

Background:

• National mortality trends in critically ill children are crucial for improving survival rates.
• Limited data exists on pediatric intensive care unit (ICU) mortality trends in South Korea.
• Understanding these trends informs targeted interventions and healthcare policy.

Purpose of the Study:

• To analyze national mortality and incidence trends of critically ill children in South Korea from 2012 to 2018.
• To identify factors associated with changes in in-hospital mortality among pediatric ICU patients.
• To evaluate the impact of ICU organization and staffing on mortality outcomes.

Main Methods:

• Analysis of the Korean National Health Insurance database for children (<18 years) admitted to ICUs between 2012-2018 (excluding neonates).
• Multivariable logistic regression to assess the association between admission year and in-hospital mortality.
• Evaluation of subgroup trends based on admission department, age, intensivist presence, pediatric ICU admission, mechanical ventilation, and vasopressor use.

Main Results:

• Overall pediatric intensive care unit mortality was 4.4%, with a significant decrease from 5.5% in 2012 to 4.1% in 2018 (P<0.001).
• Annual adjusted in-hospital mortality decreased by 9.2% (P<0.001).
• Mortality reduction was significantly associated with the presence of dedicated intensivists and admission to a pediatric ICU.

Conclusions:

• Critically ill children experienced improved survival rates during the study period, particularly those with high treatment needs.
• The study underscores the importance of structural support for medical advancements in pediatric critical care.
• Variations in mortality trends by ICU organization emphasize the need for specialized pediatric critical care infrastructure.