In-hospital Pediatric Mortality Research Articles

Causes of in-hospital pediatric mortality

The purpose of the study is to determine the trends and causes of in-hospital mortality among the children’s population of the Russian Federation, to establish the relationship of its level with the resource provision of medical care. Materials and methods. The level and structure of the causes of in-hospital mortality in children’s population of the Russian Federation over 2015-2020 were studied. The interrelation between its level and the resource provision of medical care for children (medical personnel, bed fund) was established. Results. Against the background of the revealed decrease in the level of in-hospital mortality, unfavourable trends in mortality of children aged 0-17 years from congenital anomalies, diseases of the nervous, endocrine and genitourinary systems were noted. In its structure, the largest share was accounted for by individual conditions of the perinatal period, congenital anomalies and neoplasms. There were similar trends, i.e. gradual decrease, in the trend in in- hospital mortality among children under the age of 1 year of life. However, there was an increase in mortality of children from diseases of the nervous, endocrine systems and neoplasms. In the structure of in-hospital mortality, the largest proportion were individual conditions of the perinatal period, congenital anomalies and diseases of the nervous system. There was an unstable decrease in daily mortality in all age groups. Among those who died on the first day of admission to the hospital, the overwhelming majority were children under 1 year of life. A statistically significant correlation of the level of in-hospital mortality with the provision of medical personnel (pediatricians, and neonatologists) and with the level of their qualifications was revealed. The greatest degree of inverse correlation of hospital mortality was established with the provision of pathology of newborns and premature babies with beds and less (statistically not significant) with pediatric and specialized beds. Conclusion. The level and structure of pediatric in-hospital mortality should serve as an important criterion in assessing the quality of medical care in inpatient medical institutions and be the basis for the development of differentiated measures to reduce it.

Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes

ObjectiveTo evaluate the association between hyperoxia in the first 24 hours after in-hospital pediatric cardiac arrest and mortality and poor neurological outcome. MethodsThis is a retrospective cohort study of inpatients in a freestanding children’s hospital. We included all patients younger than 18 years of age with in-hospital cardiac arrest between December 2012 and December 2019, who achieved return of circulation (ROC) for longer than 20 minutes, survived at least 24 hours after cardiac arrest, and had documented PaO2 or SpO2 during the first 24 hours after ROC. Hyperoxia was defined as having at least one level of PaO2 above 200 mmHg in the first 24 hours after cardiac arrest. ResultsThere were 187 patients who met eligibility criteria, of whom 48% had hyperoxia during the first 24 hours after cardiac arrest. In-hospital mortality was 41%, with similar mortality between oxygenation groups (hyperoxia 45% vs no hyperoxia 38%). We did not observe an association between hyperoxia and in-hospital mortality or poor neurological outcome after adjusting for confounders (odds ratio 1.2, 95% confidence interval 0.5–2.8). On sensitivity analysis using two additional cutoffs of PaO2 (>150 mmHg and > 300 mmHg), there was also no association with in-hospital mortality or poor neurological outcome after adjusting for confounders. Similarly, on multivariable logistic regression using SpO2 > 99% as the exposure, there was no difference in the frequency of death or poor neurological outcome at hospital discharge. ConclusionHyperoxia after pediatric cardiac arrest was common and was not associated with worse in-hospital outcomes.

Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock.

In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock. Prospective, cohort-outcome study, conducted 2013-2017. Twelve academic PICUs in the United States. Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale. Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life. This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock.

Facility characteristics and inhospital pediatric mortality after severe traumatic brain injury.

More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in inhospital mortality after pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day inhospital mortality after pediatric severe TBI. We hypothesized that, even after accounting for patient-level characteristics associated with mortality, the characteristics of facilities where patients received care would be associated with inhospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 6707 pediatric patients hospitalized with severe TBI in 391 facilities and investigated their risk of 30-day inhospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, census region, facility size, nonprofit status, and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the Midwest (risk ratio [RR]=1.42; 95% confidence interval [CI] 1.12-1.81) and South (RR=1.39; 95% CI: 1.12-1.72) regions had higher likelihoods of 30-day inhospital mortality compared with patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the largest investigations to identify regional variation in inhospital mortality after pediatric severe TBI in a national sample after accounting for individual and other facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making for pediatric severe TBI care across different settings.

Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran.

Introduction:Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality.Materials and Methods:In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied.Results:From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%).Conclusion:We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.

Racial-Ethnic Differences in Pediatric Higher Body Mass Index: Hospital-Based Access Explanatory Model

s / Annals of Epidemiology 24 (2014) 682e702 689 examine the independent effects of race/ethnicity on HPV vaccine series completion. Results: Despite similar initiation rates, Hispanic girls who had initiated the series were less likely to complete the series than non-Hispanic whites (60.0% vs. 69.4%). After accounting for age at HPV series initiation, mother’s education, and home ownership, disparities in completion rates were not statistically significant. Age at interview and age at HPV series initiationwere associated with completion for Hispanics. Continuous health insurance since 11 years of age, age at HPV series initiation, home ownership, and number of children in the household were associated with HPV series completion for non-Hispanic whites. Conclusions: This study confirms previous findings that Hispanic adolescent girls have lower overall completion rates of the HPV vaccine series than nonHispanic Whites among initiators. Differences in completion rates could be addressed by early initiation of the HPV vaccine series. P28. Lower Regional Pediatric In-hospital Mortality Albeit Racial/Ethnic Disparities Laurens Holmes PhD, DrPH, MPH, Brianne Earnest, Oceanic Patricia MS, Diane Fitzgerald BSN, MEd, RN, Arie L. Nettles PhD, Kelli Grant AS, Kirk Dabney MD, MHCDS. Nemours Center for Childhood Cancer Research Purpose: Pediatric mortality (PM) continues to vary by race/ethnicity, and racial/ethnic minorities tend to bear disproportionately the burden. We aimed to assess the prevalence of PM, racial/ethnic disparities, and possible explanation for the variations. Methods: Using a non-concurrent cohort study, we examined the medical records of patients diagnosed with any pediatric condition during 2009 and 2010 in our institution (Delaware Valley). Death from all causes was the primary outcome variable. Other variables studied were race, vital status, sex, length of stay (LOS), severity of illness (SOI), income and insurance status. Chi-square statistic and logistic regression models were used. Results: The in-hospital pediatric mortality prevalence was relatively low (86 deaths, 0.5%) compared to similar settings in U.S (national average range 0.8% to 1.1%). African Americans (AA) and Some Other Race (SOR) had slightly higher overall mortality compared to others, AA (2.6%) and SOR (3.5%). Income indicated an inverse trend with mortality; compared to children in the lowest (1st) quartile those in 2nd, 3rd, and 4th were 7%, 26% and 37% less likely to die respectively. Relative to Caucasians, Asians were 61% less likely to die, while AA were 5% and SOR were 48% more likely to die, OR,1.48, 95% CI,1.15-1.91. After controlling for potential confounders (SOI, insurance status, LOS), racial disparities did not persist between Caucasians and SOR, adjusted OR 1⁄4 1.08, 99% CI 1⁄4 0.75-1.5. Conclusion: In-hospital pediatric mortality prevalence is relatively low, and racial disparities in PM exist, but did not persist after controlling for insur-

Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and plateletocrit (PCT) as predictors of in-hospital pediatric mortality

Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and plateletocrit (PCT) as predictors of in-hospital pediatric mortality

Socioeconomic Status and In-Hospital Pediatric Mortality

Socioeconomic status (SES) is inversely related to pediatric mortality in the community. However, it is unknown if this association exists for in-hospital pediatric mortality. Our objective was to determine the association of SES with in-hospital pediatric mortality among children's hospitals and to compare observed mortality with expected mortality generated from national all-hospital inpatient data. This is a retrospective cohort study from 2009 to 2010 of all 1,053,101 hospitalizations at 42 tertiary care, freestanding children's hospitals. The main exposure was SES, determined by the median annual household income for the patient's ZIP code. The main outcome measure was death during the admission. Primary outcomes of interest were stratified by income and diagnosis-based service lines. Observed-to-expected mortality ratios were created, and trends across quartiles of SES were examined. Death occurred in 8950 (0.84%) of the hospitalizations. Overall, mortality rates were associated with SES (P < .0001) and followed an inverse linear association (P < .0001). Similarly, observed-to-expected mortality was associated with SES in an inverse association (P = .014). However, mortality overall was less than expected for all income quartiles (P < .05). The association of SES and mortality varied by service line; only 3 service lines (cardiac, gastrointestinal, and neonatal) demonstrated an inverse association between SES and observed-to-expected mortality. Within children's hospitals, SES is inversely associated with in-hospital mortality, but is lower than expected for even the lowest SES quartile. The association between SES and mortality varies by service line. Multifaceted interventions initiated in the inpatient setting could potentially ameliorate SES disparities in in-hospital pediatric mortality.

Socioeconomic Status and In-Hospital Pediatric Mortality

Socioeconomic Status and In-Hospital Pediatric Mortality

Infections Led Causes of In-Hospital Pediatric Mortality

Infections Led Causes of In-Hospital Pediatric Mortality