Abstract
BackgroundThe length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission.MethodsWe performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017.ResultsOverall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%). An 11-variable simple predictive scoring system was constructed, including Pediatric Index of Mortality 2 ≥ 1 (2 points), liver dysfunction (non-post operation) (2 points), post-cardiopulmonary resuscitation (1 point), circulatory disorder (1 point), post-operative management of liver transplantation (1 point), encephalitis/encephalopathy (1 point), myocarditis/cardiomyopathy (1 point), congenital heart disease (non-post operation) (1 point), lung tissue disease (1 point), Pediatric Cerebral Performance Category scores ≥ 2 (1 point), and age < 2 years (1 point). A score of ≥ 3 points yielded an area under the receiver operating characteristic curve (AUC) of 0.79, sensitivity of 87.0%, and specificity of 59.4% in the original dataset. Reproducibility was confirmed with the internal validation dataset (AUC 0.80, sensitivity 92.6%, and specificity 60.2%).ConclusionsPediatric LSPs possess a significant presence in Japanese ICUs with high rates of bed utilization and mortality. The newly developed predictive scoring system may identify pediatric LSPs on admission.
Highlights
The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator for resource consumption and for health outcomes of patients
The registry is securely held at the National Center of Child Health and Development (NCCHD) and anonymized data are provided to the principal investigator on request with a specific study protocol that was approved by the Japanese Registry of Pediatric Acute Care (JaRPAC) steering committee
Statistical analysis After we examined the distribution of LOS in ICUs to define the Long-stay patient (LSP), we conducted a descriptive analysis of the participants overall or stratified by the LSP
Summary
The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator for resource consumption and for health outcomes of patients. Long-stay patients (LSPs) in intensive care units (ICUs) are generally accepted as being susceptible to higher mortality than short-stay patients (SSPs) [1]. They consume a higher amount of medical costs, resources, and ICU capacity [2]. Multiple studies reported that they are responsible for more than one third of ICU bed days the proportion of LSPs among the entire admitted population is smaller than 10% [3, 5,6,7] It is often the case for pediatric LSPs that their functional outcomes are unfavorable (moderate or severe disabilities, and death) [8]. These basic data are essential for discussion to improve the current ICU practices for pediatric patients, Japan has little data about pediatric LSPs in the ICU
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