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Long-Term Survival of Children Discharged From Pediatric Intensive Care: A Linked Data Cohort Study
Anthony Slater1,2,3, Shaila Chavan4, Elizabeth Croston5
1Department of Paediatric Intensive Care Medicine, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
Insights
Long-term survival for children discharged from pediatric intensive care units (PICUs) has improved, with a 40% reduction in mortality risk over time. Underlying conditions and geographic location impact post-discharge survival rates.
Area of Science:
- Pediatric critical care medicine
- Public health
- Epidemiology
Background:
- Long-term survival outcomes for children after pediatric intensive care unit (PICU) discharge are not well-established.
- Factors influencing mortality post-PICU discharge require systematic investigation.
Purpose of the Study:
- To describe the long-term survival of children discharged alive from Australian PICUs.
- To identify factors associated with mortality following PICU discharge.
Main Methods:
- A cohort data linkage study utilizing the Australian and New Zealand Paediatric Intensive Care Registry and the Australian National Death Index.
- Analysis included 96,743 children discharged from Australian PICUs between 1997 and 2018.
- Multivariable Cox proportional hazards models and Kaplan-Meier survival curves were employed.
Main Results:
- Overall risk of death post-discharge decreased significantly over time, with a 40% reduction observed from 1997-2002 to 2014-2018.
- Children with low-risk conditions (e.g., asthma) had a 70% lower risk of death, while those with very-high-risk conditions (e.g., malignancy) had a seven-fold increased risk.
- Residence in outer regional and very remote areas was associated with a higher risk of death.
Conclusions:
- Survival rates for children discharged from Australian PICUs have improved demonstrably.
- Key factors influencing post-discharge survival include the nature of underlying diseases, patient age, and geographic location, particularly areas with limited healthcare access.
Objectives:
The long-term survival of children discharged from PICUs and factors associated with mortality following discharge have not been systematically studied. The objective was to describe the long-term survival of children discharged alive from Australian PICUs and identify factors associated with death after discharge.
Design:
A cohort data linkage study.
Setting:
The Australian and New Zealand Paediatric Intensive Care Registry linked with the Australian National Death Index.
Patients:
Children discharged from PICUs in Australia between 1997 and 2018.
Interventions:
None.
Measurements And Main Results:
Exposures included the time period of admission, demographic, social, and admission factors. A multivariable Cox proportional hazards model and Kaplan-Meier survival curves were used to investigate exposures associated with mortality. The records of 96,743 children were available for analysis. The risk of death reduced over time: compared with children admitted from 1997 to 2002, the hazard ratios for death after discharge for children admitted from 2003-2008, 2009-2013, to 2014-2018 were 0.92 (95% CI, 0.85-0.99), 0.69 (0.64-0.745), and 0.60 (0.55-0.65). The risk of death associated with low-risk underlying conditions, such as asthma, was 70% lower than the reference (standard risk) group, while there was a seven-fold increase in the risk of death with very-high-risk underlying conditions, such as malignancy. Residing in outer regional and very remote areas was associated with higher risk of death.
Conclusions:
The survival of children discharged from Australian PICUs has improved over time; the risk of death reduced by 40% over the study period. The underlying disease, age, and residing in locations with reduced access to healthcare were associated with reduced probability of survival after discharge.
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