RESOURCE CONSUMPTION IN A PEDIATRIC ICU

Abstract

Using the Therapeutic Intervention Scoring System (TISS) and ICU days to measure resource consumption in a PICU, we prospectively examined care distribution to patients by age, goals of therapy, acute and chronic disease status. Methods: Resource utilization was assessed for each patient group as total TISS per patient, % total TISS per group, and total ICU days. TISS per patient was adjusted for severity of illness using analysis of covariance. Results: Data was collected on 396 admissions (2,202 days, 54,018 TISS points). Children under one month of age received significantly more therapy than those > one month (405 vs 114 TISS per patient, p<.0001). Of the total,65% were admitted for definitive therapy, 13% for observation, and 22% for palliative therapy. TISS per patient was higher in the palliative therapy group than in other groups. 32% of the patients had significant chronic disease expected to alter life expectancy and had higher TISS per patient per day scores than others(24 vs 20 TISS/pt./day,p<.001). Infants with acute congenital disease received more therapy than other children with acute onset disease, 532 vs 120 TISS/pt., p<.0001).Those admitted to the PICU following surgery received less therapy and had shorter stays. Discussion:Even after adjusting resource consumption for severity of illness,this study shows the disproportionate consumption of PICU resources by those under one month of age, those with congenital disease, and those with significant chronic disease. Less care was consumed by older children, postoperative patients, and those admitted for observation.