Long-term mortality and functional outcome after prolonged paediatric intensive care unit stay

Eur J Pediatr. 2019 Feb;178(2):155-160. doi: 10.1007/s00431-018-3278-8. Epub 2018 Oct 27.

Abstract

We performed a retrospective, observational study of patients who had spent > 14 days in the paediatric intensive care unit (PICU) of our hospital from 2011 to 2013. Specifically, long-term mortality, functional outcome, and PICU resource occupancy were examined. All prolonged-stay patients in our study were < 15 years of age. Favourable outcomes were defined as a Pediatric Overall Performance Category (POPC) score of 1-2, and unfavourable outcomes as a POPC score of 3-6 or death. During the study period, there were 1082 PICU admissions involving 805 patients, 111 (13.8%) of whom had one or more prolonged PICU stays. Among these patients, 100 (90%) survived to PICU discharge and 92 (83%) survived to hospital discharge. At the 3-year follow-up, the survival rate was 75% (77/102; nine patients were lost to follow-up) and the favourable outcome rate was 43% (44/102) (57% among survivors). Prolonged PICU-stay patients accounted for 50.5% of the PICU patient-days. Extremely prolonged stays (≥ 28 days) correlate with low favourable outcome rates (P = 0.03), but did not correlate with mortality rates (P = 0.16).Conclusion: Although prolonged PICU-stay patients utilized many PICU resources, most survived at least 3 years, and > 50% of the survivors had a favourable functional outcome (POPC score). What is Known: • The number of patients with prolonged paediatric intensive care unit (PICU) stays is increasing. • These patients utilize many resources and are at high risk for mortality and disabilities. What is New: • Although prolonged-stay patients accounted for 50% of PICU patient-days, their 3-year survival rate and favourable functional outcome rate (based on Pediatric Overall Performance Category scores) were relatively high. • Extremely prolonged stays (≥ 28 days) correlate with low favourable functional outcomes but not with mortality.

Keywords: Long-term outcome; Mortality; Paediatric intensive care units; Pediatric Overall Performance Category; Prolonged; Resource.

Publication types

  • Observational Study

MeSH terms

  • Child, Preschool
  • Female
  • Health Resources / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Length of Stay / statistics & numerical data*
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data
  • Retrospective Studies
  • Survival Rate