Multidisciplinary Assessment of Patients Co-managed by Pediatric Rheumatology and the Pediatric Intensive Care Unit

This study aimed to describe the diagnostic spectrum, management strategies, and outcomes of critically ill children co-managed by rheumatology and the pediatric intensive care unit (PICU).

A retrospective cohort study was conducted at a tertiary referral hospital PICU with integrated pediatric rheumatology collaboration between August 2016 and January 2025. Patients were categorized into 2 groups: Group 1 comprised children with a previously established rheumatologic diagnosis prior to PICU admission (n=20), and Group 2 comprised children without a known rheumatologic diagnosis at PICU admission who were either newly diagnosed during the PICU stay or required pediatric rheumatology involvement for hyperin-flammatory conditions (n=67). Patients who neither received a rheumatologic diagnosis norrequired pediatric rheumatology involvement during PICU admission were excluded. Data on demographic characteristics, diagnoses, treatments, and mortality were analyzed.

In Group 1, vasculitis (35%), systemic lupus erythematosus (SLE, 25%), and systemic juvenile idiopathic arthritis (30%) predominated; most were admitted with disease flare. Mortality was highest in SLE (60% in Group 1, 43% overall). In Group 2, secondary hemophagocytic lymphohistiocytosis (HLH) was the most common diagnosis (n=56). Mortality reached 28.3% in secondary HLH. Non-survivors more frequently required mechanical ventilation within the first 24 hours of PICU admission. Median PICU stay ranged from 5 days in vasculitis to 13 days in SLE.

Critically ill children co-managed by rheumatology and intensive care teams most often present with hyperinflammatory syndromes. Early rheumatology involvement and multidisciplinary care appear essential for optimal patient outcomes.