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Pediatric intensive care: factors that influence outcome
Critical Care Medicine
|January 1, 1982
Summary
Therapeutic Intervention Scoring System (TISS) use in pediatric intensive care units (PICUs) revealed that 75% of patient days involved high-acuity care. While TISS correlated with mortality, reducing congenital malformations and trauma is key to lowering PICU deaths.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Health Services Research
Background:
- The Therapeutic Intervention Scoring System (TISS) is used to quantify patient acuity.
- Understanding resource utilization and factors influencing outcomes in Pediatric Intensive Care Units (PICUs) is crucial for optimizing care.
- High acuity care represents a significant portion of PICU resource utilization.
Purpose of the Study:
- To evaluate the utility of the Therapeutic Intervention Scoring System (TISS) in a Pediatric Intensive Care Unit (PICU).
- To identify primary reasons for admission and factors associated with increased mortality in critically ill children.
- To assess the relationship between illness severity, length of stay, and hospitalization costs in a pediatric critical care setting.
Main Methods:
- Retrospective analysis of 461 consecutive admissions to a PICU.
- Application of the Therapeutic Intervention Scoring System (TISS) to assess patient acuity.
- Comparison of mortality rates and cost of care between survivors and nonsurvivors.
Main Results:
- Patients requiring high-acuity care (TISS ≥ 10) constituted 75% of patient days.
- Congenital heart disease, trauma, malignancy, respiratory failure, and sepsis were leading causes for high-acuity admission.
- Survival was inversely related to TISS points; however, TISS alone could not differentiate survivors from nonsurvivors.
- Mortality was significantly increased in children with congenital malformations, pre-admission cardiac arrest, or acute failure.
- Critically ill children and adults showed similar mortality rates when assessed by TISS.
- Hospitalization costs were not disproportionately higher for nonsurvivors compared to survivors.
Conclusions:
- TISS is a valuable tool for assessing acuity in PICU patients, but other factors significantly impact mortality.
- Reducing mortality in PICUs necessitates addressing factors beyond ICU practitioners' control, such as congenital malformations and childhood trauma prevention.
- While TISS aids in understanding resource needs, long-term cost-effectiveness requires further investigation.
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