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Daham S, Larsson E, Eksborg S, Hamrin TH. Mortality following admission to the paediatric intensive care unit: A Swedish longitudinal cohort study. Acta Paediatr 2024. [PMID: 38994852 DOI: 10.1111/apa.17352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
AIM This study aimed to compare outcomes post-admission to a Swedish paediatric intensive care unit (PICU) in children with complex chronic conditions (CCC) and without CCC. METHODS In this observational registry-based study, consecutive admissions to the Astrid Lindgren Children's Hospital PICU from 1 January 2008 to 31 December 2016 were analysed. Data on demographics, predicted death rates (PDR), admission diagnoses and causes of death were collected. Mortality was recorded up to 15 years after admission and compared between groups. RESULTS Patients with CCC constituted 64.6% (n = 3026) of PICU admissions and 83.5% (n = 111) of PICU deaths. The crude mortality rate in PICU was 2.84% overall. CCC-patients were 2.83 times more likely to die in PICU compared to non-CCC (OR 2.83; 95% CI: 1.78-4.49). Mortality increased in the CCC-cohort up to 5 years after PICU discharge, while non-CCC patients generally survived if they survived in PICU. Of the patients who died in PICU, the median PDR was 22.9% for CCC-patients and 66.5% in the non-CCC cohort. CONCLUSION Children with CCC accounted for most admissions and deaths in PICU. Despite lower severity of illness scores upon admission, CCC patients were nearly three times more likely to die in PICU compared to non-CCC patients.
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Affiliation(s)
- Shanay Daham
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Eksborg
- Department of Paediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Tova Hannegård Hamrin
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Rowe S, Best KM. Individualized Numeric Rating Scale to Assess Pain in Critically Ill Children With Neurodevelopmental Disabilities. Am J Crit Care 2024; 33:280-288. [PMID: 38945815 DOI: 10.4037/ajcc2024343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators. OBJECTIVES To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities. METHODS This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods. RESULTS For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses. CONCLUSIONS The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.
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Affiliation(s)
- Shaneel Rowe
- Shaneel Rowe is a study coordinator, Clinical Research Support Office, Children's Hospital of Philadelphia, Penn-sylvania
| | - Kaitlin M Best
- Kaitlin M. Best is a nurse practitioner, Cardiac Critical Care Unit, the Hospital for Sick Children, Toronto, Ontario, Canada
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White MJ, Sutton AG, Ritter V, Fine J, Chase L. Interfacility Transfers Among Patients With Complex Chronic Conditions. Hosp Pediatr 2021; 10:114-122. [PMID: 31988068 DOI: 10.1542/hpeds.2019-0105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe interfacility transfers among children with complex chronic conditions (CCCs) and determine if interfacility transfer was associated with health outcomes. We hypothesized that interfacility transfer would be associated with length of stay (LOS), receipt of critical care services, and in-hospital mortality. METHODS In this retrospective cohort study, we used data from the 2012 Kids' Inpatient Database. CCC hospitalizations were identified by International Classification of Diseases, Ninth Revision codes. Receipt of critical care services was inferred by using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. We performed a descriptive analysis of CCC hospitalizations then determined if transfer was associated with LOS, mortality, or receipt of critical care services using survey-adapted quasi-Poisson or logistic regression models, controlling for hospital and patient demographics. RESULTS There were 551 974 non-birth hospitalizations with at least 1 CCC diagnosis code. Of these, 13% involved an interfacility transfer. Compared with patients with CCCs who were not transferred, patients with CCCs who were transferred in and ultimately discharged from the receiving hospital had an adjusted LOS rate ratio of 1.6 (95% confidence interval [CI]: 1.5-1.7; P < .001), were more likely to have received critical care services (adjusted odds ratio 3.0; 95% CI: 2.7-3.2; P < .001), and had higher in-hospital mortality (adjusted odds ratio 3.6; 95% CI: 3.2-3.9; P < .001) (controlling for patient and hospital characteristics). CONCLUSIONS Many hospitalizations for children with CCCs involve interfacility transfer. Compared with in-house admissions, hospitalizations of patients who are transferred in and ultimately discharged from the receiving hospital involve longer LOS, greater odds of receipt of critical care services, and in-hospital mortality. Further evaluation of the role of clinical and transfer logistic factors is needed to improve outcomes.
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Affiliation(s)
- Michelle J White
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
| | - Ashley G Sutton
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
| | - Victor Ritter
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason Fine
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsay Chase
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
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Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective. CHILDREN-BASEL 2021; 8:children8040254. [PMID: 33805106 PMCID: PMC8064072 DOI: 10.3390/children8040254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.
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Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, Healy M, Doyle C, Masterson K. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr 2021; 180:1-12. [PMID: 32710305 PMCID: PMC7380164 DOI: 10.1007/s00431-020-03737-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
There are an increasing number of children who are dependent on medical technology to sustain their lives. Although significant research on this issue is taking place, the terminology used is variable and the concept of technology dependence is ill-defined. A systematic concept analysis was conducted examining the attributes, antecedents, and consequences of the concept of technology dependent, as portrayed in the literature. We found that this concept refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide ranging sequelae for the child and family, and health and social care delivery.Conclusion: The term technology dependent is increasingly redundant. It objectifies a heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. What is Known: • There are an increasing number of children who require medical technology to sustain their life, commonly referred to as technology dependent. This concept analysis critically analyses the relevance of the term technology dependent which is in use for over 30 years. What is New: • Technology dependency refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide-ranging sequelae for the child and family, and health and social care delivery. • The paper shows that the term technology dependent is generally portrayed in the literature in a problem-focused manner. • This term is increasingly redundant and does not serve the heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. More appropriate child-centred terminology will be determined within the TechChild project.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Denise Alexander
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Mary Brigid Quirke
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Jessica Eustace-Cook
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Piet Leroy
- grid.5012.60000 0001 0481 6099Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC and Faculty of Health, Life Sciences & Medicine, Maastricht University, Maastricht, Netherlands
| | - Jay Berry
- grid.2515.30000 0004 0378 8438Department of Medicine and Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Martina Healy
- Department of Paediatric Anaesthesia, Paediatric Critical Care Medicine and Paediatric Pain Medicine, Children’s Health Ireland Crumlin, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705School of Medicine, Faculty of Health Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Carmel Doyle
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Kate Masterson
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland ,grid.416107.50000 0004 0614 0346Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia
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Murphy Salem S, Graham RJ. Chronic Illness in Pediatric Critical Care. Front Pediatr 2021; 9:686206. [PMID: 34055702 PMCID: PMC8160444 DOI: 10.3389/fped.2021.686206] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Children and Youth with Special Healthcare Needs (CYSHCN), children with medical complexity (CMC), and children with chronic, critical illness (CCI) represent pediatric populations with varying degrees of medical dependance and vulnerability. These populations are heterogeneous in underlying conditions, congenital and acquired, as well as intensity of baseline medical needs. In times of intercurrent illness or perioperative management, these patients often require acute care services in the pediatric intensive care (PICU) setting. This review describes epidemiologic trends in chronic illness in the PICU setting, differentiates these populations from those without significant baseline medical requirements, reviews models of care designed to address the intersection of acute and chronic illness, and posits considerations for future roles of PICU providers to optimize the care and outcomes of these children and their families.
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Affiliation(s)
- Sinead Murphy Salem
- Department of Anesthesiology, Boston Children's Hospital, Critical Care and Pain Medicine and Harvard Medical School, Boston, MA, United States
| | - Robert J Graham
- Department of Anesthesiology, Boston Children's Hospital, Critical Care and Pain Medicine and Harvard Medical School, Boston, MA, United States
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Wolfler A, Piastra M, Amigoni A, Santuz P, Gitto E, Rossetti E, Tinelli C, Montani C, Savron F, Pizzi S, D'amato L, Mondardini MC, Conti G, De Silvestri A. A shared protocol for porcine surfactant use in pediatric acute respiratory distress syndrome: a feasibility study. BMC Pediatr 2019; 19:203. [PMID: 31215483 PMCID: PMC6580470 DOI: 10.1186/s12887-019-1579-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Pediatric ARDS still represents a difficult challenge in Pediatric Intensive Care Units (PICU). Among different treatments proposed, exogenous surfactant showed conflicting results. Aim of this multicenter retrospective observational study was to evaluate whether poractant alfa use in pediatric ARDS might improve gas exchange in children less than 2 years old, according to a shared protocol. Methods The study was carried out in fourteen Italian PICUs after dissemination of a standardized protocol for surfactant administration within the Italian PICU network. The protocol provides the administration of surfactant (50 mg/kg) divided in two doses: the first dose is used as a bronchoalveolar lavage while the second as supplementation. Blood gas exchange variations before and after surfactant use were recorded. Results Sixty-nine children, age 0–24 months, affected by Acute Respiratory Distress Syndrome treated with exogenous porcine surfactant were enrolled. Data collection consisted of patient demographics, respiratory variables and arterial blood gas analysis. The most frequent reasons for PICU admission were acute respiratory failure, mainly bronchiolitis and pneumonia, and septic shock. Fifty-four children (78.3%) had severe ARDS (define by oxygen arterial pressure and inspired oxygen fraction ratio (P/F) < 100), 15 (21.7%) had moderate ARDS (100 < P/F < 200). PO2, P/F, Oxygenation Index (OI) and pH showed a significant improvement after surfactant use with respect to baseline (p < 0.001 at each included time-point for each parameter). No significant difference in blood gas variations were observed among four different subgroups of diseases (bronchiolitis, pneumonia, septic shock and others). Overall, 11 children died (15.9%) and among these, 10 (90.9%) had complex chronic conditions. Two children (18.2%) died while being treated with Extracorporeal Membrane Oxygenation (ECMO). Mortality for severe pARDS was 20.4%. Conclusion The use of porcine Surfactant improves oxygenation, P/F ratio, OI and pH in a population of children with moderate or severe pARDS caused by multiple diseases. A shared protocol seems to be a good option to obtain the same criteria of enrollment among different PICUs and define a unique way of use and administration of the drug for future studies.
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Affiliation(s)
- Andrea Wolfler
- Division of Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Via Castelvetro 32, 20152, Milan, Italy.
| | - Marco Piastra
- Pediatric ICU, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Amigoni
- Pediatric ICU, Department of Woman's and Child's Health, University Hospital, Padova, Italy
| | - Pierantonio Santuz
- Department of Neonatal and Pediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Eloisa Gitto
- Pediatric ICU, Pediatric Department, University Hospital G Martino, Messina, Italy
| | - Emanuele Rossetti
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit - Foundation IRCCS San Matteo, Pavia, Italy
| | - Cinzia Montani
- Pediatric ICU, Department of Anesthesia and Intensive Care, Foundation IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Savron
- Pediatric ICU, Department of Anesthesia and Intensive Care, Institute for Maternal and Child health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Simone Pizzi
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Salesi, Ancona, Italy
| | - Luigia D'amato
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Naples, Italy
| | - Maria Cristina Mondardini
- Pediatric ICU, Department of Pediatric Anesthesia and Intensive Care, University Hospital St. Orsola Malpighi Polyclinic, Bologna, Italy
| | - Giorgio Conti
- Pediatric ICU, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit - Foundation IRCCS San Matteo, Pavia, Italy
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Best KM, Asaro LA, Curley MAQ. Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment. J Pediatr 2019; 206:204-211.e1. [PMID: 30527750 PMCID: PMC6389364 DOI: 10.1016/j.jpeds.2018.10.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/29/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare current analgesia and sedation management practices between critically ill children with pre-existing cognitive impairment and critically ill neurotypical children, including possible indicators of therapeutic efficacy. STUDY DESIGN This study used secondary analysis of prospective data from the RESTORE clinical trial, with 2449 children admitted to the pediatric intensive care unit and receiving mechanical ventilation for acute respiratory failure. Subjects with a baseline Pediatric Cerebral Performance Category ≥3 were defined as subjects with cognitive impairment, and differences between groups were explored using regression methods accounting for pediatric intensive care unit as a cluster variable. RESULTS This study identified 412 subjects (17%) with cognitive impairment. Compared with neurotypical subjects, subjects with cognitive impairment were older (median, years, 6.2 vs 1.4; P < .001) with more severe pediatric acute respiratory distress syndrome (40% vs 33%; P = .009). They received significantly lower cumulative doses of opioids (median, mg/kg, 14.2 vs 16.2; P < .001) and benzodiazepines (10.6 vs 14.4; P < .001). Three nonverbal subjects with cognitive impairment received no analgesia or sedation. Subjects with cognitive impairment were assessed as having more study days awake and calm and fewer study days with an episode of pain. They were less likely to be assessed as having inadequate pain/sedation management or unplanned endotracheal/invasive tube removal. Subjects with cognitive impairment had more documented iatrogenic withdrawal symptoms than neurotypical subjects. CONCLUSIONS Subjects with cognitive impairment in this study received less medication, but it is unclear whether they have authentically lower analgesic and/or sedative requirements or are vulnerable to inadequate assessment of discomfort because of the lack of validated assessment tools. We recommend the development of pain and sedation assessment tools specific to this patient population.
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Affiliation(s)
- Kaitlin M Best
- Department of Nursing, Respiratory Care and Neurodiagnostic Services, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Martha A Q Curley
- The Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Family and Community Health, School of Nursing, Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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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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10
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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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Prout AJ, Talisa VB, Carcillo JA, Mayr FB, Angus DC, Seymour CW, Chang CCH, Yende S. Children with Chronic Disease Bear the Highest Burden of Pediatric Sepsis. J Pediatr 2018; 199:194-199.e1. [PMID: 29753542 PMCID: PMC6063765 DOI: 10.1016/j.jpeds.2018.03.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To describe the contemporary epidemiology of pediatric sepsis in children with chronic disease, and the contribution of chronic diseases to mortality. We examined the incidence and hospital mortality of pediatric sepsis in a nationally representative sample and described the contribution of chronic diseases to hospital mortality. STUDY DESIGN We analyzed the 2013 Nationwide Readmissions Database using a retrospective cohort design. We included non-neonatal patients <19 years of age hospitalized with sepsis. We examined patient characteristics, the distribution of chronic disease, and the estimated national incidence, and described hospital mortality. We used mixed effects logistic regression to explore the association between chronic diseases and hospital mortality. RESULTS A total of 16 387 admissions, representing 14 243 unique patients, were for sepsis. The national incidence was 0.72 cases per 1000 per year (54 060 cases annually). Most (68.6%) had a chronic disease. The in-hospital mortality was 3.7% overall-0.7% for previously healthy patients and 5.1% for patients with chronic disease. In multivariable analysis, oncologic, hematologic, metabolic, neurologic, cardiac and renal disease, and solid organ transplantation were associated with increased in-hospital mortality. CONCLUSIONS More than 2 of 3 children admitted with sepsis have ≥1 chronic disease and these patients have a higher in-hospital mortality than previously healthy patients. The burden of sepsis in hospitalized children is greatest in pediatric patients with chronic disease.
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Affiliation(s)
- Andrew J. Prout
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor B. Talisa
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Florian B. Mayr
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Derek C. Angus
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher W. Seymour
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H. Chang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sachin Yende
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
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Reese J, Scott TA, Patrick SW. Changing patterns of patent ductus arteriosus surgical ligation in the United States. Semin Perinatol 2018; 42:253-261. [PMID: 29954594 PMCID: PMC6512985 DOI: 10.1053/j.semperi.2018.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
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Affiliation(s)
- Jeff Reese
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN
| | - Theresa A. Scott
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN
| | - Stephen W. Patrick
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN,Center for Health Services Research, Vanderbilt Center for Child Health Policy, Nashville, TN,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN,Corresponding author. (S.W. Patrick)
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Nandi D, Lin KY, O'Connor MJ, Elci OU, Kim JJ, Decker JA, Price JF, Zafar F, Morales DLS, Denfield SW, Dreyer WJ, Jefferies JL, Rossano JW. Hospital Charges for Pediatric Heart Failure-Related Hospitalizations from 2000 to 2009. Pediatr Cardiol 2016; 37:512-8. [PMID: 26645995 PMCID: PMC4814313 DOI: 10.1007/s00246-015-1308-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/12/2015] [Indexed: 01/27/2023]
Abstract
Scarce data exist regarding costs of pediatric heart failure-related hospitalizations (HFRH) or how costs have changed over time. Pediatric HFRH costs, due to advances in management, will have increased significantly over time. A retrospective analysis of Healthcare Cost and Utilization Project Kids' Inpatient Database was performed on all pediatric HFRH. Inflation-adjusted charges are used as a proxy for cost. There were a total of 33,189 HFRH captured from 2000 to 2009. Median charges per HFRH rose from $35,079 in 2000 to $72,087 in 2009 (p < 0.0001). The greatest median charges were incurred in patients on extracorporeal membrane oxygenation ($442,134 vs $53,998) or ventricular assist devices ($462,647 vs $55,151). Comorbidities, including sepsis ($207,511 vs $48,995), renal failure ($180,624 vs $52,812), stroke ($198,260 vs $54,974) and respiratory failure ($146,200 vs $48,797), were associated with greater charges (p < 0.0001). Comorbidities and use of mechanical support increased over time. After adjusting for these factors, later year remained associated with greater median charges per HFRH (p < 0.0001). From 2000 to 2009, there has been an almost twofold increase in pediatric HFRH charges, after adjustment for inflation. Although comorbidities and use of mechanical support account for some of this increase, later year remained independently associated with greater charges. Further study is needed to understand potential factors driving these higher costs over time and to identify more cost-effective therapies in this population.
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Affiliation(s)
- Deipanjan Nandi
- Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Kimberly Y Lin
- Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Matthew J O'Connor
- Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Okan U Elci
- The Children's Hospital of Philadelphia/Westat, Biostatistics and Data Management, Philadelphia, PA, USA
| | - Jeffrey J Kim
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jamie A Decker
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Jack F Price
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Susan W Denfield
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - William J Dreyer
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - John L Jefferies
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Joseph W Rossano
- Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Benneyworth BD, Bennett WE, Carroll AE. Cross-sectional comparison of critically ill pediatric patients across hospitals with various levels of pediatric care. BMC Res Notes 2015; 8:693. [PMID: 26584713 PMCID: PMC4653873 DOI: 10.1186/s13104-015-1550-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/05/2015] [Indexed: 11/12/2022] Open
Abstract
Background Inpatient administrative data sources describe the care provided to hospitalized children. The Kids’ Inpatient Database (KID) provides nationally representative estimates, while the Pediatric Health Information System (PHIS, a consortium of pediatric facilities) derives more detailed information from revenue codes. The objective was to contextualize a diagnosis and procedure-based definition of critical illness to a revenue-based definition; then compare it across hospitals with different levels of pediatric care. Methods This retrospective, cross-sectional study utilized the 2009 KID, and 2009 inpatient discharges from the PHIS database. Patients <21 years of age (excluding neonates) were included to focus on pediatric critical illness. Critical illness was defined as: (1) critical care services (CC services) using diagnosis and procedures codes and (2) intensive care unit (ICU) care using revenue codes. Demographics, invasive procedures, and categories of critical illness were compared using Chi square and survey-weighted methods. The definitions of critical illness were compared in PHIS hospitals. CC services populations identified in General Hospitals, Pediatric Facilities, and Freestanding Children’s hospitals (from KID) were compared to those in PHIS hospitals. Results Among PHIS hospitals, critically ill discharges identified by CC services accounted for 37.7 % of ICU care. CC services discharges were younger and had greater proportion of respiratory illness and invasive procedure use. Critically ill patients identified by CC services in PHIS hospitals were statistically similar to those in Freestanding Children’s hospitals. Pediatric Facilities and General Hospitals had more adolescents with more traumas. CC services patients in general hospitals had lower use of invasive procedures and predominance of trauma, respiratory illness, mental health issues, and general infections. Freestanding children’s hospitals discharged 22 % of the estimated 96,700 CC services cases. Similar proportions of critically ill patients were seen in Pediatric Facilities (31 %) and General Hospitals (33 %). Conclusion The CC services definition captured a more severely ill fraction of critically ill children. Critically ill discharges from PHIS hospitals can likely be extrapolated to Freestanding Children’s hospitals and Pediatric Facilities. General Hospitals, which provide a significant amount of pediatric critical care, are different. Studies utilizing administrative data can benefit from multiple data sources, which balance the individual strengths and weaknesses. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1550-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Brian D Benneyworth
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dive, RI 2117, Indianapolis, IN, 46202, USA.
| | - William E Bennett
- Section of Pediatric Gastroenterology, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dive, RI 4210, Indianapolis, IN, 46202, USA. .,Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, 410 West 10th Street, HS Suite 4099C, Indianapolis, IN, 46202, USA.
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, 410 West 10th Street, HS Suite 4099C, Indianapolis, IN, 46202, USA.
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Health-related quality of life following pediatric critical illness. Intensive Care Med 2015; 41:1235-46. [PMID: 25851391 DOI: 10.1007/s00134-015-3780-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/25/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The aims of this focused review of the literature on children surviving critical illness were to (1) determine whether health-related quality of life (HRQL) represents a clinically meaningful outcome measure for children surviving critical illness and (2) evaluate the HRQL measures implemented in pediatric critical care studies to date. METHODS This was a focused review of the literature from 1980 to 2015 based on a search of EMBASE/PubMed, MEDLINE and PsycInfo assessing trends and determinants of HRQL outcomes in children surviving critical illness. We also evaluated the psychometric properties of the HRQL instruments used in the studies identified by examining each measure's reported reliability, validity and sensitivity to clinical change. RESULTS The literature search identified 253 pediatric articles for potential inclusion in the review, among which data from 78 studies were ultimately selected for inclusion. Of the 22 measures utilized in the studies reviewed, only four demonstrated excellent psychometric properties for use in pediatric critical care trials. Trends in HRQL identified in the studies reviewed suggest significant ongoing morbidity for children surviving critical illness. Key determinants of poor HRQL outcomes include reason for PICU admission (sepsis, meningoencephalitis, trauma), antecedents (chronic comorbid conditions), treatments received (prolonged cardiopulmonary resuscitation, long-stay patients, invasive technology), psychological outcomes (post-traumatic stress disorder, parent anxiety/depression) and social and environmental characteristics (low socioeconomic status, parental education and functioning). CONCLUSIONS Validated pediatric HRQL instruments are now available. Significant impact on HRQL has been demonstrated in acute and acute on chronic critical illness. Future pediatric critical care interventional trials should include both mortality as well as long-term HRQL measurements to truly ascertain the full impact of critical illness in children.
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Güzel Y, Koç ZP, Mitil HA, Köm M, Özer AB, Özercan Hİ, Balcı TA. Brain death scintigraphy and pathology results in a rat model. EXP CLIN TRANSPLANT 2013; 12:143-7. [PMID: 24188426 DOI: 10.6002/ect.2013.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Brain scintigraphy with Tc-99m-labeled diethylenetriaminopenta-acetic acid is a sensitive diagnostic method showing loss of cerebral blood flow that occurs after brain death. Cerebral blood flow can be quantitatively estimated by this method. The aim of this study was to compare histopathologic changes occurring with the decrease of cerebral blood flow (as shown by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy) after brain death in an experimental model. MATERIALS AND METHODS The study included examination of cerebral blood flow by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy in the 20 rats, 1 day before brain death, after producing brain death in 11 surviving rats. Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy was performed under intubation and monitored. The Mann-Whitney U test was performed to compare groups (scintigraphic quantification results before and after brain death). RESULTS In the time activity curves generated from the analysis of the scintigraphies, decreases in counts in the brain death group were obtained in the arterial phase (P < .01). Decreases of the cerebral blood flow between the first and the sixth minutes were statistically significant (P < .05). Common principal histopathologic changes of the brain death (ie, autolysis and color loss in the nerve cells, diffuse edema, petechial hemorrhage in the brain tissues) were observed in all subjects. CONCLUSIONS Quantitative findings of the brain scintigraphy by Tc-99m-labeled diethylenetriaminopenta-acetic acid was related with the histopathologic findings seen during the early brain death, with significant decreases of the cerebral blood flow. Quantification of Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy as an easier and less-expensive scintigraphic method of cerebral blood flow might indicate a definite diagnosis of brain death and thus, potential donors can be determined earlier, leaving to increased transplant rates.
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Affiliation(s)
- Yunus Güzel
- Department of Nuclear Medicine, Firat University Medical Faculty, Elazig, Turkey
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Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay*. Crit Care Med 2012; 40:2196-203. [PMID: 22564961 DOI: 10.1097/ccm.0b013e31824e68cf] [Citation(s) in RCA: 231] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of chronic conditions among children admitted to U.S. pediatric intensive care units and to assess whether patients with complex chronic conditions experience pediatric intensive care unit mortality and prolonged length of stay risk beyond that predicted by commonly used severity-of-illness risk-adjustment models. DESIGN, SETTING, AND PATIENTS Retrospective cohort analysis of 52,791 pediatric admissions to 54 U.S. pediatric intensive care units that participated in the Virtual Pediatric Intensive Care Unit Systems database in 2008. MEASUREMENTS Hierarchical logistic regression models, clustered by pediatric intensive care unit site, for pediatric intensive care unit mortality and length of stay >15 days. Standardized mortality ratios adjusted for severity-of-illness score alone and with complex chronic conditions. MAIN RESULTS Fifty-three percent of pediatric intensive care unit admissions had complex chronic conditions, and 18.5% had noncomplex chronic conditions. The prevalence of these conditions and their organ system subcategories varied considerably across sites. The majority of complex chronic condition subcategories were associated with significantly greater odds of pediatric intensive care unit mortality (odds ratios 1.25-2.9, all p values < .02) compared to having a noncomplex chronic condition or no chronic condition, after controlling for age, gender, trauma, and severity-of-illness. Only respiratory, gastrointestinal, and rheumatologic/orthopedic/psychiatric complex chronic conditions were not associated with increased odds of pediatric intensive care unit mortality. All subcategories were significantly associated with prolonged length of stay. All noncomplex chronic condition subcategories were either not associated or were negatively associated with pediatric intensive care unit mortality, and most were not associated with prolonged length of stay, compared to having no chronic conditions. Among this group of pediatric intensive care units, adding complex chronic conditions to risk-adjustment models led to greater model accuracy but did not substantially change unit-level standardized mortality ratios. CONCLUSIONS Children with complex chronic conditions were at greater risk for pediatric intensive care unit mortality and prolonged length of stay than those with no chronic conditions, but the magnitude of risk varied across subcategories. Inclusion of complex chronic conditions into models of pediatric intensive care unit mortality improved model accuracy but had little impact on standardized mortality ratios.
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Cimiotti JP, Barton SJ, Chavanu Gorman KE, Sloane DM, Aiken LH. Nurse reports on resource adequacy in hospitals that care for acutely ill children. J Healthc Qual 2012; 36:25-32. [PMID: 22713115 DOI: 10.1111/j.1945-1474.2012.00212.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the estimated 1.8 million children admitted to hospitals annually, little is known about the quality of care and the adequacy of resources in hospitals that care for acutely ill infants and children. Using survey data from 3,819 pediatric nurses working in 498 hospitals, we found that nursing resources vary significantly across different types of hospitals that care for children. Nurses working in a children's hospital within a hospital, and on a pediatric unit in a general hospital were more likely than nurses in freestanding children's hospitals to report inadequate nursing resources. We also found that inadequate nursing resources were associated with surveillance left undone and missed changes in patients' condition. These findings have implications for the quality and safety of pediatric care.
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Barfield WD, Krug SE, Kanter RK, Gausche-Hill M, Brantley MD, Chung S, Kissoon N. Neonatal and pediatric regionalized systems in pediatric emergency mass critical care. Pediatr Crit Care Med 2011; 12:S128-34. [PMID: 22067921 PMCID: PMC4561175 DOI: 10.1097/pcc.0b013e318234a723] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Improved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches. METHODS In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. TASK FORCE RECOMMENDATIONS States and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity.
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Affiliation(s)
- Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics 2011; 127:e1533-41. [PMID: 21576303 PMCID: PMC3103275 DOI: 10.1542/peds.2010-2026] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective was to describe the characteristics of pediatric discharges associated with long-term mechanical ventilation (LTMV) compared with those with complex chronic conditions (CCCs), and evaluate trends over time in health care utilization for the discharges associated with LTMV. METHODS The Kids' Inpatient Database, compiled by the Agency for Healthcare Research and Quality, was used. Routine newborn care was excluded. Discharges associated with LTMV were identified by using the International Classification of Diseases, Ninth Revision, code v46.1x and compared with discharges associated with CCCs in 2006 using simple regression and χ(2) analyses. Trends in LTMV-associated discharges from 2000 to 2006 were assessed using variance-weighted least squares regression. RESULTS In 2006, there were an estimated 7812 discharges associated with LTMV. Compared with discharges for children with CCCs, LTMV discharges had significantly higher mortality, longer lengths of stay, higher mean charges, more emergency department admissions, and more discharges to long-term care. From 2000 to 2006, there was a 55% increase in the number of LTMV discharges and a concurrent 70% increase in aggregate hospital charges. The majority of LTMV discharges occurred in children 4 years old and younger, and ∼50% of the aggregate charges were for children younger than 1 year. CONCLUSIONS Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger.
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Affiliation(s)
- Brian D. Benneyworth
- Child Health Evaluation and Research Unit, Division of General Pediatrics, ,Division of Pediatric Critical Care Medicine, and
| | | | - Sarah J. Clark
- Child Health Evaluation and Research Unit, Division of General Pediatrics
| | | | - Matthew M. Davis
- Child Health Evaluation and Research Unit, Division of General Pediatrics, ,Division of General Medicine and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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