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Comparative assessment of pediatric intensive care in Moscow, the Russian Federation: a prospective, multicenter
J V DiCarlo1, T A Zaitseva, T V Khodateleva
1Russian office of Project HOPE, Russian Federation, Moscow.
Insights
Pediatric intensive care units in Moscow showed higher observed mortality than predicted, especially in lower-risk patients. This suggests moderate efficiency and below-standard effectiveness compared to Western benchmarks.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality assessment
- Public health
Background:
- Pediatric intensive care units (PICUs) are crucial for managing critically ill children.
- Assessing the effectiveness and efficiency of PICUs is vital for improving patient outcomes.
- Previous assessments of pediatric intensive care in Moscow were limited.
Purpose of the Study:
- To quantitatively assess the effectiveness and efficiency of pediatric intensive care in Moscow.
- To compare observed mortality rates with predicted mortality using the Pediatric Risk of Mortality (PRISM) score.
- To identify areas for improvement in pediatric critical care services.
Main Methods:
- A prospective, multicenter study involving four PICUs in Moscow over a 6-month period.
- Inclusion of 583 consecutive pediatric admissions (age ≤ 14 years).
- Effectiveness measured by the ratio of observed to predicted mortality (PRISM score); efficiency assessed based on mortality risk and ICU-dependent therapies.
Main Results:
- Observed mortality rates were consistently higher than predicted across all four hospitals (Standardized Mortality Ratio: 1.10-1.83, mean 1.32).
- Excess mortality was concentrated in low- and medium-risk patient strata.
- Admission efficiency was moderate, with a mean of 60.4% across institutions.
Conclusions:
- Pediatric intensive care in Moscow demonstrates moderate efficiency and below-standard effectiveness in lower-risk patient groups compared to Western standards.
- Suboptimal nurse/patient ratios on general wards may contribute to a low threshold for PICU admission.
- Further research should investigate specific treatment protocols, adherence, and complications to enhance pediatric critical care quality.
Objective:
Comparative assessment of pediatric intensive care.
Design:
Prospective multicenter study.
Setting:
Four pediatric intensive care units in Moscow, the Russian Federation.
Patients:
Consecutive unselected admissions (n = 583), < or = 14 yrs of age, in a 6-month period.
Interventions:
None.
Measurements And Main Results:
Effectiveness was defined as the ratio of observed to predicted mortality, based on prediction by Pediatric Risk of Mortality (PRISM) severity of illness scoring. Efficiency (on the day of admission only) depended on either a mortality risk of > 1% or the administration of intensive care unit-dependent therapies. In all four hospitals, observed mortality rates were higher than expected, with a range of standardized mortality ratios between 1.10 and 1.83 (mean 1.32). The excess mortality was found in the low- and medium-risk strata (risk of mortality of < 1% to 15%). Admission efficiency ratings did not fluctuate greatly between institutions (mean 60.4%, range 55.7 to 65.9).
Conclusions:
We provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.
