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Mahalingam S, Bhaskar V, Batra P, Dewan P, Gogoi P. Hematological Indices for Identifying Adverse Outcomes in Children Admitted to Pediatric ICUs. Cureus 2024; 16:e53744. [PMID: 38465050 PMCID: PMC10920964 DOI: 10.7759/cureus.53744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The pediatric ICU (PICU) is a specialized area where critically sick children are managed. The mortality rates in PICUs are higher in developing countries as compared to developed nations. Many of these deaths could be prevented if very sick children were identified soon after they arrived at the health facility. Hematological indices like platelet lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) have been frequently used in adults as indicators of mortality. However, their use in the pediatric population is limited due to a lack of validated reference intervals. OBJECTIVE The objective of the study is to assess the role of hematological indices in identifying adverse outcomes in terms of mortality in children admitted to the PICU. MATERIALS AND METHODS It is a prospective, observational study done at a tertiary care hospital. All children aged one year to 12 years admitted to the PICU were enrolled in the study. A sample for complete blood count was taken within one hour of admission to the PICU. Children who had received blood products in the last two months, those on chronic medications (>two weeks) that can affect bone marrow cellularity, and known cases of hematological disorders such as megaloblastic anemia, hematological malignancies, immune thrombocytopenia, and aplastic anemia were excluded from the study. PLR, NLR, and platelets to mean platelet volume ratio (PLT/MPV) were determined and compared among the survivors and non-survivors. RESULTS Out of 275 enrolled patients, 119 (43.3%) patients expired during the study period. While PLR had high sensitivity and NLR had high specificity (85.71% and 92.31%, respectively) for predicting mortality, none of these parameters had a good area under the curve (AUC) in our study. PLT/MPV of ≥32 had a sensitivity of 39.5% and a specificity of 56.41% for predicting mortality. CONCLUSIONS Hematological parameters have been used across the world to predict ICU mortality. PLR and NLR are simple hematological biomarkers, easy to calculate, and cost-effective, and ratios are better than individual parameters. More studies and stratified samples are required to evaluate the role of hematological markers in identifying the risk of mortality in children admitted to PICUs.
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Affiliation(s)
| | - Vikram Bhaskar
- Pediatrics, University College of Medical Sciences, Delhi, IND
| | - Prerna Batra
- Pediatrics, University College of Medical sciences, Delhi, IND
| | - Pooja Dewan
- Pediatrics, University College of Medical Sciences, Delhi, IND
| | - Priyanka Gogoi
- Transfusion Medicine, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
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Choi J, Park E, Choi AY, Son MH, Cho J. Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study. J Korean Med Sci 2023; 38:e178. [PMID: 37309697 DOI: 10.3346/jkms.2023.38.e178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/24/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Monitoring mortality trends can help design ways to improve survival, but observation of national mortality trends in critically ill children is lacking for the Korean population. METHODS We analyzed the incidence and mortality trends of children younger than 18 years admitted to an intensive care unit (ICU) from 2012 to 2018 using the Korean National Health Insurance database. Neonates and neonatal ICU admissions were excluded. Multivariable logistic regression analyses were performed to estimate the odds ratio of in-hospital mortality according to admission year. Trends in incidence and in-hospital mortality of subgroups according to admission department, age, presence of intensivists, admissions to pediatric ICU, mechanical ventilation, and use of vasopressors were evaluated. RESULTS The overall mortality of critically ill children was 4.4%. There was a significant decrease in mortality from 5.5% in 2012 to 4.1% in 2018 (P for trend < 0.001). The incidence of ICU admission in children remained around 8.5/10,000 population years (P for trend = 0.069). In-hospital mortality decreased by 9.2% yearly in adjusted analysis (P < 0.001). The presence of dedicated intensivists (P for trend < 0.001, mortality decrease from 5.7% to 4.0%) and admission to pediatric ICU (P for trend < 0.001, mortality decrease from 5.0% to 3.2%) were associated with significant decreasing trends in mortality. CONCLUSION Mortality among critically ill children improved during the study period, and the improving trend was prominent in children with high treatment requirements. Varying mortality trends, according to ICU organizations, highlight that advances in medical knowledge should be supported structurally.
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Affiliation(s)
- Jaeyoung Choi
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Esther Park
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Ah Young Choi
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Meong Hi Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Association Between Centralization and Outcome for Children Admitted to Intensive Care in Australia and New Zealand: A Population-Based Cohort Study. Pediatr Crit Care Med 2022; 23:919-928. [PMID: 36040098 DOI: 10.1097/pcc.0000000000003060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs). DESIGN A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018. SETTING Population-based study in ANZ. PATIENTS A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions). CONCLUSIONS Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.
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Centralization of Pediatric Critical Care Services-It Seems to Work in Australia and New Zealand. Is It Right for All? Pediatr Crit Care Med 2022; 23:952-954. [PMID: 36326462 DOI: 10.1097/pcc.0000000000003083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Enomoto Y, Tsuchiya A, Tsutsumi Y, Kikuchi H, Ishigami K, Osone J, Togo M, Yasuda S, Inoue Y. Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service. Pediatr Emerg Care 2021; 37:365-370. [PMID: 30211837 DOI: 10.1097/pec.0000000000001608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients. METHODS This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan. We reviewed the database for air medical transports conducted at our institution from July 2010 to December 2016. RESULTS During the 6.5-year period, the Ibaraki HEMS attended to 288 children. The median age of the children was 11 (interquartile range, 5-14) years. Of the total, 196 (68.1%) of the children had trauma-related injuries. The head was the most common site of significant injuries (12.4%). The most common cause of nontrauma incidents was seizure (9.0%). In 65.9% of the patients, the injury or illness was of mild or moderate severity at the scene. An intervention was applied at the scene in 76.0% of the cases: 75.1%, intravenous route; 6.9%, intubation; and 13.4%, drug administration. Of those patients, 29.1% were discharged from the emergency department. In-hospital mortality accounted for 1.5% (n = 2) of the cases. CONCLUSIONS Although the condition at the scene of most of the pediatric patients transported by the physician-staffed HEMS was not severe, an intervention was frequently applied from the scene. Improving the dispatch criteria and monitoring compliance are needed for appropriate use of HEMS.
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Affiliation(s)
| | | | - Yusuke Tsutsumi
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Koji Ishigami
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Junpei Osone
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Masahito Togo
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Susumu Yasuda
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Tsukuba University Hospital, Ibaraki
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Hoffmann F, Landeg M, Rittberg W, Hinzmann D, Steinbrunner D, Hey F, Heinen F, Kanz KG, Bogner-Flatz V. [Childhood emergencies-worsening healthcare bottlenecks for children in a systematic long-term analysis of the EMS system in a German metropolis]. Med Klin Intensivmed Notfmed 2021; 117:358-366. [PMID: 34156483 DOI: 10.1007/s00063-021-00831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children have the right to the best possible medical care. The lack of treatment capacity is rising steadily and increasingly leads to forced centralized allocation of patients by the emergency medical services (EMS) to pediatric emergency departments that are, officially, temporarily "closed". AIM The aim of this study is to present trends in allocation of pediatric emergency patients in greater Munich. MATERIALS AND METHODS Retrospective analysis of hospital admissions of children < 18 years of age collected from 01 January 2015 to 31 December 2019 by means of the web-based IT system IVENA eHealth (manis IT, Frankfurt) used by the emergency medical services. The focus of the evaluation is on patients in category II, who are likely to require inpatient admission. RESULTS During the 5‑year observation period, a total of 44,549 pediatric patients < 18 years of age (90.6% of total admissions) were admitted to a children's hospital by the ambulance service as category II (SKII) in the Munich metropolitan area. These patients showed an increase in the relative frequency of forced allocations from 1.7% (2015) to 9.4% (2019). Parallel to this, there is an increasing frequency of time intervals over the years in which all children's hospitals were temporarily closed due to lack of treatment availability, especially in the winter half-year. CONCLUSION In the examined period from 2015 to 2019, there has been a relevant increase in the number of forced allocations to children's hospitals by the emergency medical services in the Munich area. This observed trend is likely to persist over the coming years, in view of current staff shortages and diminishing hospital capacities.
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Affiliation(s)
- F Hoffmann
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
| | - M Landeg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - W Rittberg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - D Hinzmann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
| | | | - F Hey
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - F Heinen
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Regierung von Oberbayern, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
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Demirkiran H, Kilic M, Tomak Y, Dalkiran T, Yurttutan S, Basaranoglu M, Tuncer O, Derme T, Tekeli AE, Bahar I, Keskin S, Oksuz H. Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness. PLoS One 2021; 16:e0248883. [PMID: 34048449 PMCID: PMC8162636 DOI: 10.1371/journal.pone.0248883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/06/2021] [Indexed: 11/18/2022] Open
Abstract
Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.
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Affiliation(s)
- Hilmi Demirkiran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
- * E-mail:
| | - Mehmet Kilic
- Department of Pediatrics, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Yakup Tomak
- Anesthesiology and Intensive Care Unit, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Tahir Dalkiran
- Pediatric Intensive Care Unit, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Sadik Yurttutan
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Murat Basaranoglu
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Oguz Tuncer
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Turan Derme
- Department of Pediatrics, Division of Neonatology, Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Arzu Esen Tekeli
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Ilhan Bahar
- Internal Medicine Critical Care Unit, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Siddik Keskin
- Department of Biostatistics, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Hafize Oksuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Procter C, Morrow B, Pienaar G, Shelton M, Argent A. Outcomes following admission to paediatric intensive care: A systematic review. J Paediatr Child Health 2021; 57:328-358. [PMID: 33577142 DOI: 10.1111/jpc.15381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
AIM To describe the long-term health outcomes of children admitted to a paediatric intensive care unit. METHODS A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. RESULTS One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. CONCLUSIONS There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.
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Affiliation(s)
- Claire Procter
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Genee Pienaar
- Public Health, Mental Health and Behavioral Sciences, Western Cape Department of Health, Cape Town, South Africa
| | - Mary Shelton
- Reference Librarian, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
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Guo K, Wang X, Zhang H, Wang M, Song S, Ma S. Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China. Front Pediatr 2021; 9:660297. [PMID: 34123967 PMCID: PMC8193363 DOI: 10.3389/fped.2021.660297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to describe transfusion reactions of pediatric patients from a National Center for Children's Health in China and to examine reaction incidents, reaction types by blood transfusion, and the associated blood products resulting in transfusion reactions. Methods: We compared transfusion reaction rates, among platelets, plasma, and red blood cells (RBCs) using a retrospective analysis of pediatric patients treated with blood transfusion based on data from the National Center for Children's Health (Beijing, China) by a hemovigilance reporting system from January 2015 to December 2019. Results: Over the past 5 years, 165 reactions were reported, and the overall incidence was 1.35‰ (95% CI: 1.14-1.55‰; 165/122,652); for each separate year, the incidences were 1.25‰ (95% CI: 0.76-1.74‰; 25/20,035; 2015), 1.09‰ (95% CI: 0.65-1.52‰; 24/22,084; 2016), 1.66‰ (95% CI: 1.14-2.18‰; 39/23,483; 2017), 1.36‰ (95% CI: 0.92-1.81‰; 36/26,440; 2018) and 1.34‰ (95% CI: 0.93-1.75‰; 41/30,610; 2019). Transfusion reaction incidents by person included 0.37‰ (95% CI: 0.21-0.53‰; 21/56,815) RBCs, 2.98‰ (95% CI: 2.33-3.64‰; 79/26,496) platelets and 1.65‰ (95% CI: 1.25-2.05‰; 65/39,341) frozen plasma. According to the analysis by blood products, the incidence of transfusion was 0.34‰ (95% CI: 0.20-0.48‰; 23/66,958) for RBCs, 3.21‰ (95% CI: 2.50-3.92‰; 78/24,318.5) for platelets, and 0.94‰ (95% CI: 0.71-1.17‰; 64/67,912) for frozen plasma. Transfusion reactions were most commonly associated with platelets, followed by plasma and RBC transfusions. The types of blood transfusion reactions were mainly allergic reactions (86.67%) and febrile non-hemolytic transfusion reactions (FNHTRs, 4.24%). The disease types of pediatric patients with transfusion reactions were concentrated among those with blood system diseases. A total of 80.61% of children with transfusion reactions had a previous blood transfusion history. Conclusions: Transfusion reactions are still relatively common in pediatric patients, and additional studies are necessary to address the differences in reaction rates, especially allergic and FNHTRs. Robust hemovigilance systems do include a special section dedicated to children will further the understanding of these reactions and trends, and prospective randomized clinical controlled trials may need to be conducted to perform preventive and corrective measures.
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Affiliation(s)
- Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaohuan Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huimin Zhang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Mengjian Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shanshan Song
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuxuan Ma
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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School Performance After Pediatric Intensive Care-Association of Mental Well-Being, Chronic Illnesses, and Family Socioeconomic Status. Pediatr Crit Care Med 2020; 21:e1099-e1105. [PMID: 32769702 DOI: 10.1097/pcc.0000000000002564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe school performance in pediatric intensive care survivors, as well as the influence of chronic diseases, psychological well-being, and family socioeconomic status on poor school performance. DESIGN Register-based observational descriptive follow-up study. SETTING A multicenter national study. PATIENTS All pediatric patients who were admitted to an ICU in Finland in 2009-2010. Children and adolescents of or beyond school age. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Questionnaires regarding the child's coping in school classes, chronic illnesses, as well as family socioeconomic factors were sent to every child alive 6 years after discharge from intensive care in Finland. Mental well-being was measured with the Strengths and Difficulties Questionnaire. There were 1,109 responders in an ICU group of 3,674 children. Seven-hundred fifty-three of the respondents were of school age or older. Of these, 13% (101/753) demonstrated poor school performance. Children with difficulties in school more often had a need for regular medication (71.3% vs 32.4%; p < 0.001), healthcare visits (91.1% vs 80.6%; p = 0.01), some regular therapy (60.4% vs 13.7%; p < 0.001), chronic illnesses (86.3% vs 48.4%; p < 0.001), or additional ICU admissions (36.5% vs 14.9%; p = 0.003). Schooling difficulties were reported more often in children with abnormal Strengths and Difficulties Questionnaire scores compared to those with normal or borderline scores (24.8% vs 5.4%; p < 0.001). In an adjusted logistic regression model, which included age, number of chronic diseases, and need for therapy, poor school performance was predicted by abnormal Strengths and Difficulties Questionnaire scores, nonacademic parental education, and paternal manual labor status. CONCLUSIONS Difficulties in school were more frequent when the child had chronic comorbid illnesses, especially neurologic or chromosomal abnormalities, had poor mental health, father was employed in manual labor, or parents were uneducated.
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Lerner EB, Studnek JR, Fumo N, Banerjee A, Arapi I, Browne LR, Ostermayer DG, Reynolds S, Shah MI. Multicenter Analysis of Transport Destinations for Pediatric Prehospital Patients. Acad Emerg Med 2019; 26:510-516. [PMID: 30343530 DOI: 10.1111/acem.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although all emergency departments (EDs) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for emergency medical services (EMS) providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care. OBJECTIVE The objective was to determine how frequently pediatric patients are transported by EMS to hospitals with higher-level pediatric resources and to evaluate distribution patterns based on illness and injury severity. METHODS We conducted a retrospective analysis of all pediatric (age 0-18 years) transports in three large EMS systems between November 2014 and November 2016. Each community had a hospital with higher-level pediatric resources that was within a 30-minute transport time from any location. Patients were included if they were transported by ground ambulance and the request originated in the 9-1-1 system. We assessed the frequency of transports to a hospital with higher-level pediatric resources. Data were stratified by chief complaint of illness or injury and severity. Potential risk for severe injury was defined as meeting the physiologic step of the field triage guidelines and potential risk for severe illness was defined as having an abnormal vital sign after adjusting for patient age. RESULTS A total of 41,345 pediatric patients were transported by a participating EMS agency to an ED and had complete destination data. A total of 55% of all EMS-transported pediatric patients were transported to a hospital with higher-level pediatric resources. There was variation by site (range = 45%-71%) in the percentage of children who went to a hospital with higher-level pediatric resources. Patients over 15 years of age went to general EDs (57%) more often than younger patients. When stratified by severity, 60% of those with potentially severe illness and 74% of those with potentially severe trauma were transported to a hospital with higher-level pediatric resources. CONCLUSIONS EMS providers commonly transport children to hospitals with higher-level pediatric resources. However, more than one-quarter of children with potentially severe injuries and illnesses are transported to general EDs.
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Affiliation(s)
- E. Brooke Lerner
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
- Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | | | - Nicole Fumo
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Anjishnu Banerjee
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Igli Arapi
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Lorin R. Browne
- Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | | | | | - Manish I. Shah
- Department of Pediatrics Section of Emergency Medicine Baylor College of Medicine Houston TX
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Ishihara T, Tanaka H. Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study. BMJ Paediatr Open 2019; 3:e000499. [PMID: 31531406 PMCID: PMC6720739 DOI: 10.1136/bmjpo-2019-000499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The primary objective is to clarify the clinical profiles of paediatric patients who died in intensive care units (ICUs) or paediatric intensive care units (PICUs), and the secondary objective is to ascertain the demographic differences between patients who died with and without chronic conditions. METHODS In this retrospective multicentre cohort study, we collected data on paediatric death from the Japanese Registry of Pediatric Acute Care (JaRPAC) database. We included patients who were ≤16 years of age and had died in either a PICU or an ICU of a participating hospital between April 2014 and March 2017. The causes of death were compared between patients with and without chronic conditions. RESULTS Twenty-three hospitals participated, and 6199 paediatric patients who were registered in the JaRPAC database were included. During the study period, 126 (2.1%) patients died (children without chronic illness, n=33; children with chronic illness, n=93). Twenty-five paediatric patients died due to an extrinsic disease, and there was a significant difference in extrinsic diseases between the two groups (children without chronic illness, 15 (45%); children with chronic illness, 10 (11%); p<0.01). Cardiovascular disease was the most common chronic condition (27/83, 29%). Eighty-three patients (85%) in the chronic group died due to an intrinsic disease, primarily congenital heart disease (14/93, 15%), followed by sepsis (13/93, 14%). CONCLUSIONS The majority of deaths were in children with a chronic condition. The major causes of death in children without a chronic illness were due to intrinsic factors such as cardiovascular and neuromuscular diseases, and the proportion of deaths due to extrinsic causes was higher in children without chronic illness.
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Affiliation(s)
- Tadashi Ishihara
- Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Tanaka
- Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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Factors associated with health-related quality of life 6 years after ICU discharge in a Finnish paediatric population: a cohort study. Intensive Care Med 2018; 44:1378-1387. [PMID: 30136138 DOI: 10.1007/s00134-018-5296-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/29/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE Long-term data are urgently needed in children after intensive care. The aim of this study was to measure health-related quality of life 6 years after intensive care in a paediatric intensive care population. METHODS This national, multicentre study enrolled all children and young people admitted to intensive care units (ICUs) in Finland in 2009 and 2010. The data concerning ICU stay were collected retrospectively from the ICU data registries and combined with prospective data from Paediatric Quality of Life Inventory (PedsQL 4.0) questionnaires, the generic 15D, 16D or 17D instrument, and data regarding children's chronic diagnoses and need for healthcare support. RESULTS The questionnaires were answered by 1109 of 3682 living children and adolescents admitted to an ICU, response rate was 30.1%. Among the responders, 90 children (8.4%) had poor (under - 2 SD) PedsQL scores. Children with low scores had a higher rate of chronic diagnoses (94.4% vs. 47.6%), medication on a daily basis (78.7% vs. 29.4%) and a greater need for healthcare services (97.7% vs. 82.2%) than those with normal scores. Diagnoses associated with poor quality of life were asthma, epilepsy, cerebral palsy and other neurological diseases, chromosomal alterations, cancer and long-term pain. These children were mostly admitted electively, and less frequently on an emergency basis, but no other significant differences were found during the intensive care stay. CONCLUSIONS The long-term quality of life after paediatric intensive care is good for the majority of children and young people, and it is dependent on the number of chronic diagnoses and the burden of the chronic disease, especially neurological diseases.
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Five-Year Survival and Causes of Death in Children After Intensive Care-A National Registry Study. Pediatr Crit Care Med 2018; 19:e145-e151. [PMID: 29215400 DOI: 10.1097/pcc.0000000000001424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to compare long-term mortality and causes of death in children post admission to an ICU with a control population of same age. DESIGN Longitudinal follow-up study. SETTING Registry study of a national ICU register and hospital registries. PATIENTS Children admitted to an ICU in the years 2009 and 2010. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The mortality and causes of death following ICU discharge were analyzed retrospectively. The median follow-up period was 4.9 years (25-75th percentiles, 4.4-5.5 yr). The causes of death in survivors 30 days after ICU discharge were compared with a cohort of 1 million children of the general population of same age. In total, 2,792 children were admitted to an ICU during the study period. Of those, 53 (1.9%) died in the ICU and 2,739 were discharged. Thirteen children died within 30 days of discharge, and 68 died between 30 days and the end of follow-up (December 31, 2014). In the control population (n = 1,020,407 children), there were 1,037 deaths (0.10%) from 2009 to 2014. The standardized mortality rate for the children admitted to the ICU during the study period was 53.4 (95% CI, 44.7-63.2). The standardized mortality rate for those children alive 1 year after discharge was 16.7 (12.1-22.6). One-year cumulative mortality was 3.3%. The most common causes of death in subjects alive 30 days post ICU were cancer (35.3%), neurologic (17.6%), and metabolic diseases (11.7%), whereas trauma was the most common cause in the control group (45.3%). CONCLUSIONS There was an increased risk of death in a cohort of ICU-admitted children even 3 years after discharge. In those who survived 30 days after discharge, medical causes of death were dominant, whereas deaths due to trauma were most common in the control group.
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Vossoughi S, Perez G, Whitaker BI, Fung MK, Stotler B. Analysis of pediatric adverse reactions to transfusions. Transfusion 2017; 58:60-69. [PMID: 28948619 DOI: 10.1111/trf.14359] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children are known to be physiologically and biochemically different from adults. However, there are no multi-institutional studies examining the differences in the frequency, type, and severity of transfusion reactions in pediatric versus adult patients. This study aims to characterize differences between pediatric and adult patients regarding adverse responses to transfusions. STUDY DESIGN AND METHODS This is a retrospective data analysis of nine children's hospitals and 35 adult hospitals from January 2009 through December 2015. Included were pediatric and adult patients who had a reported reaction to transfusion of any blood component. Rates are reported as per 100,000 transfusions for comparison between pediatric and adult patients. RESULTS Pediatric patients had an overall higher reaction rate compared to adults: 538 versus 252 per 100,000 transfusions, notably higher for red blood cell (577 vs. 278 per 100,000; p < 0.001) and platelet (833 vs. 358 per 100,000; p < 0.001) transfusions. Statistically higher rates of allergic reactions, febrile nonhemolytic reactions, and acute hemolytic reactions were observed in pediatric patients. Adults had a higher rate of delayed serologic transfusion reactions, delayed hemolytic transfusion reactions, and transfusion-associated circulatory overload. CONCLUSION Pediatric patients had double the rate of transfusion reactions compared to adults. The nationally reported data on reaction rates are consistent with this study's findings in adults but much lower than the observed rates for pediatric patients. Future studies are needed to address the differences in reaction rates, particularly in allergic and febrile reactions, and to further address blood transfusion practices in the pediatric patient population.
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Affiliation(s)
- Sarah Vossoughi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York.,Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, New York-Presbyterian Hospital, New York, New York
| | - Gabriela Perez
- AABB Center for Patient Safety, AABB, Bethesda, Maryland
| | | | - Mark K Fung
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont
| | - Brie Stotler
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York.,Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, New York-Presbyterian Hospital, New York, New York
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The authors reply. Pediatr Crit Care Med 2017; 18:96-97. [PMID: 28060163 DOI: 10.1097/pcc.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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