O019 / #784: TWO DECADES OF DECREASING PICU MORTALITY: BETTER CARE OR A CHANGING PATIENT GROUP?

Abstract

Aims & Objectives: Data on paediatric intensive care unit (PICU) deaths were analysed to evaluate trends in mortality and demographics. Methods: Retrospective observational study from a tertiary PICU over a 19 year period. All admissions between 1 January 2000 and 31 December 2018 were included (20,456 admissions; 14,498 patients). Primary outcome was PICU mortality. Analysis included Paediatric Index of Mortality 2 revised (PIM2r) score, length of stay (LOS), age, sex, weight. Results:Of 20,456 PICU admissions, there were 826 deaths (4.0%). Overall mortality declined from 5.4% (95% CI 4.1%-7.1%) to 2.0% (95% CI 1.3%-3.0%). Mean PIM2r score reduced from 4.7% (95% CI 4.2%-5.3%) to 3.2% (95% CI 2.7%-3.7%). This was in part attributable to an increased proportion of elective admissions (from 31% to 44%) with lower PIM2r scores. PIM2r scores of emergency admissions also reduced (from 6.1% to 4.7%). Adjusting for PIM2r score, standardised mortality ratio (SMR) fell from 1.13 to 0.62. Multivariate logistic regression analysis showed age, weight, year of admission and elective admissions were associated with decreased mortality. Mean LOS increased from 4.5 days to 5.0 days, with non-survivors having significantly longer LOS (6.3 vs 4.3 days). 5% of admissions accounted for 32% of total bed days. Conclusions: PICU mortality decreased significantly over the study period. Whilst this may be explained partly by improvements in PICU care, the nature of admissions changed: the proportion of elective admissions increased and emergency admissions had lower PIM2r scores. Future PICU training and healthcare planning should recognise and respond to this demographic change.