Abstract
BackgroundHigh-risk patients in the pediatric intensive care unit (PICU) contribute substantially to PICU-mortality. Complex chronic conditions (CCCs) are associated with death. However, it is unknown whether CCCs also increase mortality in the high-risk PICU-patient. The objective of this study is to determine if CCCs or other factors are associated with mortality in this group.MethodsRetrospective cohort study from a national PICU-database (2006–2012, n = 30,778). High-risk PICU-patients, defined as patients < 18 years with a predicted mortality risk > 30% according to either the recalibrated Pediatric Risk of Mortality-II (PRISM) or the Paediatric Index of Mortality 2 (PIM2), were included. Patients with a cardiac arrest before PICU-admission were excluded.ResultsIn total, 492 high-risk PICU patients with mean predicted risk of 24.8% (SD 22.8%) according to recalibrated PIM2 and 40.0% (SD 23.8%) according to recalibrated PRISM were included of which 39.6% died. No association was found between CCCs and non-survival (odds ratio 0.99; 95% CI 0.62–1.59). Higher Glasgow coma scale at PICU admission was associated with lower mortality (odds ratio 0.91; 95% CI 0.87–0.96).ConclusionsComplex chronic conditions are not associated with mortality in high-risk PICU patients.
Highlights
High-risk patients in the pediatric intensive care unit (PICU) contribute substantially to PICU-mortality
Patients who were already dead before PICU admission or patients admitted for palliative care, patients dying within 2 h of PICU admission, and patients transferred to another ICU during their PICU treatment were excluded from the study
Both Pediatric Risk of Mortality-II (PRISM) and Paediatric Index of Mortality 2 (PIM2) mortality risks were significantly lower in survivors compared to non-survivors
Summary
High-risk patients in the pediatric intensive care unit (PICU) contribute substantially to PICU-mortality. Complex chronic conditions (CCCs) are associated with death. It is unknown whether CCCs increase mortality in the high-risk PICU-patient. Patients with a high predicted mortality risk in the pediatric intensive care unit (PICU) are a challenge to the clinical team. Around 1% of the PICU-admissions in the Australian and New Zealand Paediatric Intensive Care Registries (ANZPIC) has a Complex chronic conditions (CCCs) are associated with prolonged length of stay in PICU patients, unplanned readmissions and death [4, 5]. Examples are spinal cord malformations, cystic fibrosis, hypoplastic left heart syndrome, extreme immaturity, metabolic disorders, etc. [7] Besides CCCs there are so called ‘noncomplex chronic conditions’ (NCCCs), diagnoses that
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