Edema description in pediatric critical care: terms, patterns, and clinical characteristics

Abstract

BackgroundNo validated methods are currently available to objectively quantify edema in critical illness. Therefore, the frequency, timing of onset, and association between edema and outcomes are unknown. Since clinicians document the presence of edema based on physical examination in the medical record, natural language processing techniques could be used to better understand its epidemiology. The objectives of this study were to describe the patterns of edema documentation by clinicians and to compare clinical characteristics and outcomes of children with and without edema.MethodsAn observational cohort study was conducted in a quaternary, university-affiliated pediatric intensive care unit (ICU). Eligible patients were aged 0–18 years and admitted to ICU for a minimum of 12 h.ResultsA total of 7884 patient admissions were studied, and a cumulative total of 211,122 notes were evaluated. Approximately, 40% of patient admissions had documented edema, of which 49% occurred before day 2 of ICU stay. The most commonly documented term across all provider types was “edema”. In multivariable regression analysis, patients who were mechanically ventilated and those with NIV, ECMO support, RRT, and vasoactive support had an increased odds of edema documentation throughout ICU stay. There was also an adjusted increased odds of death of (aOR 1.6, 95% CI of 1.1–2.2) in those with edema documented.ConclusionsEdema is documented frequently and early in ICU stay. Children with edema documented were younger, required more invasive therapies, and, in addition to greater duration of intensive care stay, had higher mortality rates.