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Published on: January 16, 2019
Complications of care in a pediatric intensive care unit: a prospective study
J J Stambouly1, L L McLaughlin, F S Mandel
1Department of Pediatrics, North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030, USA.
Insights
Pediatric intensive care unit (PICU) complications are common, with human error a significant factor. These events increase patient mortality and are best predicted by the number of complications, not patient characteristics.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Hospital quality improvement
Background:
- Complications in pediatric intensive care units (PICUs) can significantly impact patient outcomes.
- Identifying risk factors and understanding the types and severity of these complications is crucial for improving care.
Purpose of the Study:
- To determine the frequency, type, and severity of complications in a pediatric intensive care unit (PICU).
- To identify patient populations at increased risk for complications.
- To assess the impact of complications on patient morbidity and mortality.
Main Methods:
- A prospective survey was conducted over an 18-month period.
- 1035 consecutive admissions to a university-affiliated hospital's PICU were analyzed.
- Data collection focused on complication occurrence, type, severity, and associated patient factors.
Main Results:
- 8.0% of admissions (83 patients) experienced 115 complications, averaging 2.7 per 100 PICU-days.
- Ventilator-related issues were most common (52%), followed by infections (21%) and invasive device-related events (19%).
- Human error contributed to 36% of complications, with 18% being major.
- Patients with complications had higher mortality (15.7%) and longer lengths of stay.
- The number of complications and the Pediatric Risk of Mortality Score were strong predictors of mortality.
Conclusions:
- Complications significantly affect patient care and outcomes in the PICU.
- The risk of severe complications may be higher early in the PICU stay, coinciding with increased interventions.
- The number of complications is a better predictor of mortality than individual patient characteristics.
Objectives:
(a) To examine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality.
Design:
Prospective survey.
Setting:
Pediatric intensive care unit (PICU) of a university-affiliated hospital.
Patients:
1035 consecutive admissions over an 18-month period.
Results:
115 complications occurred during 83 (8.0%) admissions, for 2.7 complications per 100 PICU-days; 48 (42%) complications were major, 45 (39%) moderate, and 22 (19%) minor. Sixty complications (52%) were ventilator-related, 14 were drug-related, 13 procedure-related, 24 infectious, and 22 involved invasive devices (18 vascular catheters). Human error was involved in 41 (36%) cases, 21 of which were major (18%). Treatments included reintubation < 24 h (28), intravenous antimicrobials (24), and invasive bedside procedures (14). Cardiopulmonary resuscitation was required in 6 patients. Thirteen patients with complications died (15.7%); 2 deaths were directly due to complications. Patients with complications were younger, had longer lengths of stay, and had a higher mortality. Length of stay was a positive risk factor for complication risk (odds ratio = 1.09, 95% confidence interval: 1.05 to 1.13; p = 0.0001); other patient characteristics had no predictive effect. Kaplan-Meier estimates showed that the most severe complications occurred early in the PICU stay. The best indicators of patient mortality were number of complications (odds ratio = 2.96, 95% confidence interval 1.72 to 5.08; p = 0.0001), and mortality risk derived from the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001). Mortality was correlated with increasing severity of complications.
Conclusion:
Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest. Complications may increase patient mortality and predict patient death better than other patient variables.
