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New Morbidities During Critical Illness and Associated Risk of ICU Readmission: Virtual Pediatric Systems Cohort,
Julia A Heneghan1, Manzilat Y Akande2, Sriram Ramgopal3
1Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, MN.
Insights
Pediatric critical illness can cause new morbidities, but these did not increase PICU readmission risk. Patient functional status after critical illness is a key predictor of PICU readmission.
Area of Science:
- Pediatric critical care medicine
- Clinical outcomes research
- Patient functional status assessment
Background:
- Critical illness in children can lead to significant changes in functional status.
- Understanding factors influencing readmission after pediatric intensive care unit (PICU) stays is crucial for improving patient outcomes.
- New morbidities can develop during critical illness, but their impact on readmission risk requires further investigation.
Purpose of the Study:
- To characterize changes in Functional Status Scale (FSS) among children experiencing critical illness.
- To evaluate the development of new morbidities in critically ill children.
- To determine the association between new morbidities and PICU readmission risk.
Main Methods:
- Retrospective cohort study utilizing the Virtual Pediatric Systems (VPS) database.
- Inclusion of children younger than 21 years admitted to 126 U.S. PICUs between 2017 and 2020.
- Analysis of functional status changes, new morbidity development, and 1-year PICU readmission rates.
Main Results:
- Most children (86.2%) had good or mild functional status before illness; many maintained their FSS category during hospitalization.
- New morbidity occurred in 8.7% of survivors with initially good/mild function; hospital mortality increased with baseline dysfunction.
- 14.2% of survivors were readmitted within 1 year, with discharge functional status strongly predicting readmission (HR 5.3), not new morbidity (HR 0.7).
Conclusions:
- New morbidities are common in pediatric critical illness but do not appear to increase the hazard of PICU readmission.
- Patient functional status at discharge is a significant predictor of PICU readmission risk.
- Focusing on functional recovery may be key to reducing readmissions in this population.
Objectives:
To describe change in Functional Status Scale (FSS) associated with critical illness and assess associated development of new morbidities with PICU readmission.
Design:
Retrospective, cross-sectional cohort study using the Virtual Pediatric Systems (VPS; Los Angeles, CA) database.
Setting:
One hundred twenty-six U.S. PICUs participating in VPS.
Subjects:
Children younger than 21 years old admitted 2017-2020 and followed to December 2022.
Interventions:
None.
Measurements And Main Results:
Among 40,654 patients, 86.2% were classified as having good function or mild dysfunction before illness. Most patients did not have a change in their FSS category during hospitalization. Survival with new morbidity occurred most in children with baseline good/mild dysfunction (8.7%). Hospital mortality increased across categories of baseline dysfunction. Of 39,701 survivors, 14.2% were readmitted within 1 year. Median time to readmission was 159 days. In multivariable, mixed-effects Cox modeling, time to readmission was most associated with discharge functional status (hazard ratio [HR], 5.3 [95% CI, 4.6-6.1] for those with very severe dysfunction), and associated with lower hazard in those who survived with new morbidity (HR, 0.7 [95% CI, 0.6-0.7]).
Conclusions:
Development of new morbidities occurs commonly in pediatric critical illness, but we failed to find an association with greater hazard of PICU readmission. Instead, patient functional status is associated with hazard of PICU readmission.
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