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Published on: July 4, 2018
Patient Backgrounds and Outcomes of Mechanically Ventilated Children Treated in ICUs Versus General Wards in Japan: A
Yoshio Sakurai1, Nobuaki Michihata2, Kohei Osada1
1Department of Pediatric Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Insights
Most children requiring mechanical ventilation in Japan are treated in general wards, not intensive care units (ICUs). This study found higher in-hospital mortality for pediatric patients on mechanical ventilation in general wards compared to ICUs.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Inpatient care management
Background:
- Mechanical ventilation is standard care for critically ill adult and pediatric patients in Western countries, typically within intensive care units (ICUs).
- Concerns exist in Japan regarding the practice of treating pediatric patients requiring mechanical ventilation in general hospital wards rather than ICUs.
- This disparity necessitates an investigation into patient characteristics and treatment outcomes.
Purpose of the Study:
- To compare patient characteristics and treatment outcomes of mechanically ventilated children in general wards versus ICUs in Japan.
- To evaluate the impact of treatment location on in-hospital mortality for pediatric patients requiring mechanical ventilation.
Main Methods:
- A retrospective cohort study utilizing a national inpatient database from Japan (July 2010 - March 2022).
- Inclusion of 129,375 mechanically ventilated children aged 14 years or younger.
- 1:1 propensity score matching was employed to compare in-hospital mortality between general ward and ICU cohorts.
Main Results:
- A significant proportion of mechanically ventilated children (63% overall, 78% nonoperative, 17% postoperative) were treated in general wards.
- Intensive care unit patients were predominantly postoperative (56%), with 70% undergoing cardiac surgery.
- Propensity score matching of 15,760 pairs revealed significantly higher in-hospital mortality in general wards (6.4%) compared to ICUs (4.1%; OR, 1.49; p < 0.001).
Conclusions:
- The majority of pediatric patients requiring mechanical ventilation in Japan receive care in general wards.
- Treatment in general wards is associated with increased in-hospital mortality compared to intensive care units.
- Centralizing care for mechanically ventilated pediatric patients in ICUs is recommended to improve outcomes.
Objectives:
In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan.
Design:
A retrospective cohort study using a national inpatient database.
Setting:
The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups.
Patients:
A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study.
Interventions:
None.
Measurements And Main Results:
During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001).
Conclusions:
Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.
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