Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units

Jeffrey D Edwards,Eduard E Vasilevskis,Erika J Yoo,Amy J Houtrow,W John Boscardin,R Adams Dudley,Megumi J Okumura

doi:10.1016/j.jcrc.2014.10.016

Abstract

PurposeThe purpose of the study is to compare demographics, intensive care unit (ICU) admission characteristics, and ICU outcomes among adults with childhood-onset chronic conditions (COCCs) admitted to US pediatric and adult ICUs. Materials and methodsRetrospective cross-sectional analyses of 6088 adults aged 19 to 40 years admitted in 2008 to 70 pediatric ICUs that participated in the Virtual Pediatric Intensive Care Unit Performance Systems and 50 adult ICUs that participated in Project IMPACT. ResultsChildhood-onset chronic conditions were present in 53% of young adults admitted to pediatric units, compared with 9% of those in adult units. The most common COCC in both groups were congenital cardiac abnormalities, cerebral palsy, and chromosomal abnormalities. Adults with COCC admitted to pediatric units were significantly more likely to be younger, have lower functional status, and be nontrauma patients than those in adult units. The median ICU length of stay was 2 days, and the intensive care unit mortality rate was 5% for all COCC patients with no statistical difference between pediatric or adult units. ConclusionsThere are marked differences in characteristics between young adults with COCC admitted to pediatric ICUs and adult ICUs. Barriers to accommodating these young adults may be reasons why many such adults have not transitioned from pediatric to adult critical care.

Highlights

With improvements in medical treatments, growing numbers of persons with childhoodonset chronic conditions (COCC), such as congenital heart disease, cystic fibrosis, and cerebral palsy, are surviving into adulthood [1,2,3,4]
We reported the number of intensive care units (ICU) beds at participating hospitals and the proportion affiliated with medical schools, pediatric residencies, pediatric critical care fellowship programs, internal medicine residencies, and adult pulmonary/critical care fellowship programs
VPS and PI sites had similar proportions with pediatric and medicine residencies (77% and 74% respectively), though VPS sites were more often affiliated with a medical school and had critical care fellowship program

Summary

Introduction

With improvements in medical treatments, growing numbers of persons with childhoodonset chronic conditions (COCC), such as congenital heart disease, cystic fibrosis, and cerebral palsy, are surviving into adulthood [1,2,3,4]. For a number of reasons, pediatric institutions may no longer be the most appropriate place to care for these adults. Many adults with COCCs continue to receive emergency, inpatient, and critical care from pediatric hospitals [9,10,11,12,13]. While adults with COCCs admitted to U.S pediatric and adult inpatient services have been studied [9], few studies have focused on those admitted to intensive care units (ICU). Little is known of the COCC prevalence, patient characteristics, or clinical outcomes of those who utilize pediatric ICUs (PICU) as compared to adult ICUs. To prepare for the anticipated increase in the number of critically ill adults with COCCs, additional understanding of those who receive care in ICUs and of their critical care needs is an important first step

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