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Published on: April 7, 2021
Early predictors of unfavorable outcomes in pediatric acute respiratory failure
Shinya Miura1, Nobuaki Michihata2, Toshiaki Isogai3,4
1Department of Pediatrics, St. Marianna University School of Medicine, 2 Chome-16-1 Sugao, Miyamae Ward, Kawasaki, Kanagawa, Japan. shin.nya1982@gmail.com.
Insights
Many children with acute respiratory failure face poor outcomes, including death or new health issues. Older age, existing conditions, pneumonia, and lower hospital volume predict these unfavorable outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Health Services Research
Background:
- Acute respiratory failure is a major cause of critical illness in children.
- Understanding patient outcomes and early predictors is crucial for improving care.
- Unfavorable outcomes, including death or new comorbidities, require further investigation.
Purpose of the Study:
- To describe composite unfavorable outcomes in pediatric acute respiratory failure.
- To identify early predictors of unfavorable outcomes in this patient population.
- To inform risk stratification and optimize acute care services for vulnerable children.
Main Methods:
- Retrospective cohort study utilizing a Japanese national inpatient database.
- Inclusion of children under 20 years receiving ventilatory support within three days of admission for acute respiratory diseases (July 2010-March 2022).
- Analysis of in-hospital death or discharge with new comorbidities as composite unfavorable outcomes.
Main Results:
- A total of 29,362 children were analyzed; 9.1% experienced unfavorable outcomes.
- Invasive ventilation was the most common support (69.4%), with pneumonia being the leading diagnosis (58.6%).
- Logistic regression identified older age, underlying conditions, pneumonia, and low hospital volume as predictors of unfavorable outcomes.
Conclusions:
- A significant proportion of pediatric patients with acute respiratory failure experience unfavorable outcomes.
- Early identification of predictors can aid in risk stratification and targeted interventions.
- Future efforts should focus on enhancing acute care services for at-risk pediatric populations.
Objective:
Acute respiratory failure is a leading cause of critical illness in children. However, patient outcomes and early predictors of unfavorable outcomes are not well understood. This study aimed to describe composite unfavorable outcomes, defined as in-hospital death or discharge with new comorbidities, and to identify early predictors in children with acute respiratory failure in acute care hospitals.
Design:
Retrospective cohort study using a national inpatient database in Japan.
Setting:
All acute care hospitals registered in the database.
Patients:
This study included children under 20 years of age who were admitted with acute respiratory diseases between July 2010 and March 2022 and received ventilatory support within the first three days of hospitalization.
Intervention:
None.
Measurements And Main Results:
Among 29,362 eligible children, the median age was 1.2 (interquartile range, 0.3-3.7) years and 28.8% had underlying conditions. The highest level of ventilatory support within the first three days was invasive ventilation (69.4%), noninvasive ventilation (1.0%), and high-flow nasal cannula (29.7%). Respiratory diagnoses included pneumonia (58.6%), bronchiolitis (29.0%), and asthma (11.1%). Among these children, 669 (2.3%) died and 1994 (6.8%) were discharged with new comorbidities, resulting in 2663 (9.1%) children experiencing unfavorable outcomes. In the logistic regression model, older age, underlying conditions, pneumonia, and low hospital volume were associated with unfavorable outcomes after adjusting for covariates.
Conclusions:
A significant proportion of pediatric patients with acute respiratory failure experienced unfavorable outcomes, warranting future efforts to improve acute care services for at-risk children. Early predictors identified from national database analyses could inform risk stratification and optimize the provision of acute care services for vulnerable pediatric patients.
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