Pediatric intensive care outcomes: Development of new morbidities during pediatric critical care

Murray M. Pollack, Richard Holubkov, Tomohiko Funai, Amy Clark, John T. Berger, Kathleen Meert, Christopher J L Newth, Thomas Shanley, Frank Moler, Joseph Carcillo, Robert A. Berg, Heidi Dalton, David L. Wessel, Rick E. Harrison, Allan Doctor, J. Michael Dean, Tammara L. Jenkins

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Conclusions: The prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.

Measurements and Main Results: The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.

Objective: To investigate significant new morbidities associated with pediatric critical care.

Design: Randomly selected, prospective cohort.

Setting: PICU patients from eight medical and cardiac PICUs.

Patients: This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.

Original languageEnglish (US)
Pages (from-to)821-827
Number of pages7
JournalPediatric Critical Care Medicine
Volume15
Issue number9
DOIs
StatePublished - Nov 10 2014

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Critical Care
Pediatrics
Morbidity
Mortality
Cardiovascular Diseases
Outcome Assessment (Health Care)

Keywords

  • Critical care
  • Functional status
  • Functional status score
  • Intensive care
  • Morbidity
  • Outcome prediction
  • Pediatric critical care
  • Pediatric intensive care
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Pollack, M. M., Holubkov, R., Funai, T., Clark, A., Berger, J. T., Meert, K., ... Jenkins, T. L. (2014). Pediatric intensive care outcomes: Development of new morbidities during pediatric critical care. Pediatric Critical Care Medicine, 15(9), 821-827. https://doi.org/10.1097/PCC.0000000000000250
Pollack, Murray M. ; Holubkov, Richard ; Funai, Tomohiko ; Clark, Amy ; Berger, John T. ; Meert, Kathleen ; Newth, Christopher J L ; Shanley, Thomas ; Moler, Frank ; Carcillo, Joseph ; Berg, Robert A. ; Dalton, Heidi ; Wessel, David L. ; Harrison, Rick E. ; Doctor, Allan ; Dean, J. Michael ; Jenkins, Tammara L. / Pediatric intensive care outcomes : Development of new morbidities during pediatric critical care. In: Pediatric Critical Care Medicine. 2014 ; Vol. 15, No. 9. pp. 821-827.
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Pollack, MM, Holubkov, R, Funai, T, Clark, A, Berger, JT, Meert, K, Newth, CJL, Shanley, T, Moler, F, Carcillo, J, Berg, RA, Dalton, H, Wessel, DL, Harrison, RE, Doctor, A, Dean, JM & Jenkins, TL 2014, 'Pediatric intensive care outcomes: Development of new morbidities during pediatric critical care', Pediatric Critical Care Medicine, vol. 15, no. 9, pp. 821-827. https://doi.org/10.1097/PCC.0000000000000250

Pediatric intensive care outcomes : Development of new morbidities during pediatric critical care. / Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Clark, Amy; Berger, John T.; Meert, Kathleen; Newth, Christopher J L; Shanley, Thomas; Moler, Frank; Carcillo, Joseph; Berg, Robert A.; Dalton, Heidi; Wessel, David L.; Harrison, Rick E.; Doctor, Allan; Dean, J. Michael; Jenkins, Tammara L.

In: Pediatric Critical Care Medicine, Vol. 15, No. 9, 10.11.2014, p. 821-827.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pediatric intensive care outcomes

T2 - Development of new morbidities during pediatric critical care

AU - Pollack, Murray M.

AU - Holubkov, Richard

AU - Funai, Tomohiko

AU - Clark, Amy

AU - Berger, John T.

AU - Meert, Kathleen

AU - Newth, Christopher J L

AU - Shanley, Thomas

AU - Moler, Frank

AU - Carcillo, Joseph

AU - Berg, Robert A.

AU - Dalton, Heidi

AU - Wessel, David L.

AU - Harrison, Rick E.

AU - Doctor, Allan

AU - Dean, J. Michael

AU - Jenkins, Tammara L.

PY - 2014/11/10

Y1 - 2014/11/10

N2 - Conclusions: The prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.Measurements and Main Results: The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.Objective: To investigate significant new morbidities associated with pediatric critical care.Design: Randomly selected, prospective cohort.Setting: PICU patients from eight medical and cardiac PICUs.Patients: This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.

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KW - Critical care

KW - Functional status

KW - Functional status score

KW - Intensive care

KW - Morbidity

KW - Outcome prediction

KW - Pediatric critical care

KW - Pediatric intensive care

KW - Pediatrics

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