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Pediatr Crit Care Med. 2014 Nov;15(9):821-7. doi: 10.1097/PCC.0000000000000250.

Pediatric intensive care outcomes: development of new morbidities during pediatric critical care.

Author information

1
1Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 6Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 9Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD.

Abstract

OBJECTIVE:

To investigate significant new morbidities associated with pediatric critical care.

DESIGN:

Randomly selected, prospective cohort.

SETTING:

PICU patients from eight medical and cardiac PICUs.

PATIENTS:

This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.

MEASUREMENTS AND MAIN RESULTS:

The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.

CONCLUSIONS:

The prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.

PMID:
25226501
PMCID:
PMC4221484
DOI:
10.1097/PCC.0000000000000250
[Indexed for MEDLINE]
Free PMC Article

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