Mortality following admission to the paediatric intensive care unit: A Swedish longitudinal cohort study
Shanay Daham1,2, Emma Larsson1,3, Staffan Eksborg2,4
1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with complex chronic conditions (CCC) admitted to the paediatric intensive care unit (PICU) had higher mortality rates. These children accounted for most PICU admissions and deaths, despite lower initial illness severity.
Area of Science:
- Pediatric Intensive Care
- Chronic Illness Management
- Clinical Outcomes Research
Background:
- Complex chronic conditions (CCC) are increasingly prevalent in pediatric populations.
- Understanding outcomes for children with CCC in the paediatric intensive care unit (PICU) is crucial for resource allocation and care planning.
Purpose of the Study:
- To compare outcomes in a Swedish paediatric intensive care unit (PICU) for children with and without complex chronic conditions (CCC).
Main Methods:
- An observational, registry-based study analyzed consecutive PICU admissions from 2008-2016.
- Data collected included demographics, predicted death rates (PDR), diagnoses, and causes of death.
- Mortality was tracked up to 15 years post-admission and compared between CCC and non-CCC groups.
Main Results:
- Children with CCC represented 64.6% of PICU admissions and 83.5% of PICU deaths.
- The crude PICU mortality rate was 2.84%; CCC patients were 2.83 times more likely to die in PICU (OR 2.83).
- PICU mortality for CCC patients persisted up to 5 years post-discharge, unlike non-CCC patients.
Conclusions:
- Children with CCC constitute a significant majority of PICU admissions and mortality.
- Despite lower illness severity scores on admission, CCC patients faced a nearly threefold higher risk of PICU death compared to non-CCC patients.
Aim:
This study aimed to compare outcomes post-admission to a Swedish paediatric intensive care unit (PICU) in children with complex chronic conditions (CCC) and without CCC.
Methods:
In this observational registry-based study, consecutive admissions to the Astrid Lindgren Children's Hospital PICU from 1 January 2008 to 31 December 2016 were analysed. Data on demographics, predicted death rates (PDR), admission diagnoses and causes of death were collected. Mortality was recorded up to 15 years after admission and compared between groups.
Results:
Patients with CCC constituted 64.6% (n = 3026) of PICU admissions and 83.5% (n = 111) of PICU deaths. The crude mortality rate in PICU was 2.84% overall. CCC-patients were 2.83 times more likely to die in PICU compared to non-CCC (OR 2.83; 95% CI: 1.78-4.49). Mortality increased in the CCC-cohort up to 5 years after PICU discharge, while non-CCC patients generally survived if they survived in PICU. Of the patients who died in PICU, the median PDR was 22.9% for CCC-patients and 66.5% in the non-CCC cohort.
Conclusion:
Children with CCC accounted for most admissions and deaths in PICU. Despite lower severity of illness scores upon admission, CCC patients were nearly three times more likely to die in PICU compared to non-CCC patients.
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