Comparison of clinical characteristics and healthcare resource use of pediatric chronic and non-chronic critically ill patients in intensive care units: a retrospective national registry study

Chantal Grandjean; Marie-Hélène Perez; Anne-Sylvie Ramelet; OCToPuS Consortium

doi:10.3389/fped.2023.1194833

Comparison of clinical characteristics and healthcare resource use of pediatric chronic and non-chronic critically ill patients in intensive care units: a retrospective national registry study

Front Pediatr. 2023 Jun 26:11:1194833. doi: 10.3389/fped.2023.1194833. eCollection 2023.

Authors

Chantal Grandjean^{1

2}, Marie-Hélène Perez^{1

3}, Anne-Sylvie Ramelet^{1

2}; OCToPuS Consortium

Collaborators

OCToPuS Consortium:
Anne-Laure Lauria, Angelo Polito, Nathalie Bochaton, Daniel Trachsel, Mark Marston, Silvia Schnidrig, Tilman Humpl, Bjarte Rogdo, Ellen Wild, Thomas Neuhaus, Sandra Stalder, Barbara Brotschi, Franziska von Arx, Anna-Barbara Schlüer, Thomas Riedel, Pascale Van Kleef

Affiliations

¹ Pediatric Intensive and Intermediate Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
² Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
³ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.

Abstract

Introduction: Chronic critically ill patients (CCI) in pediatric intensive care unit (PICU) are at risk of negative health outcomes, and account for a considerable amount of ICU resources. This study aimed to (a) describe the prevalence of CCI children, (b) compare their clinical characteristics and ICU resources use with non-CCI children, and (c) identify associated risk factors of CCI.

Methods: A retrospective national registry study including 2015-2017 data from the eight Swiss PICUs of five tertiary and three regional hospitals, admitting a broad case-mix of medical and surgical patients, including pre- and full-term infants. CCI patients were identified using an adapted definition: PICU length of stay (LOS) ≥8 days and dependence on ≥1 PICU technology.

Results: Out of the 12,375 PICU admissions, 982 (8%) were CCI children and compared to non-CCI children, they were younger (2.8 vs. 6.7 months), had more cardiac conditions (24% vs. 12%), and higher mortality rate (7% vs. 2%) (p < 0.001). Nursing workload was higher in the CCI compared to the non-CCI group (22 [17-27]; 21 [16-26] respectively p < 0.001). Factors associated with CCI were cardiac (aOR = 2.241) and neurological diagnosis (aOR = 2.062), surgery (aORs between 1.662 and 2.391), ventilation support (aOR = 2.278), high mortality risk (aOR = 1.074) and agitation (aOR = 1.867).

Conclusion: the results confirm the clinical vulnerability and the complexity of care of CCI children as they were defined in our study. Early identification and adequate staffing is required to provide appropriate and good quality care.

Keywords: chronic critical illness (CCI); chronic disease; critical care; health resources; intensive care units; pediatrics.

Grants and funding

This study was funded by the Marisa Sophie Foundation Switzerland, the Anna & André Livio Glauser Foundation Switzerland, the Stiftung Pflegewissenschaft Schweiz, and an ESPNIC-Gettinge research grant for the coordination and the data collection in each site.