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. 2014 Nov;15(9):821-7.
doi: 10.1097/PCC.0000000000000250.

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

Murray M Pollack  1 , 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; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
Affiliations

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

Murray M Pollack et al. Pediatr Crit Care Med. 2014 Nov.

Abstract

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.

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.

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.

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Conflict of interest statement

Conflict of Interests: There are no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Morbidity and Mortality Rates by Site
There was a significant difference among the sites for both morbidity (p<.0001) and mortality (p=.009) rates.
Figure 2
Figure 2. New Morbidities (FSS ≥ 3) as a Percentage of Baseline FSS Categories
There was no significant difference among the rates of new morbidities for survivors admitted in the baseline FSS categories (p>.8).
Figure 3
Figure 3. FSS Categories at Baseline, PICU Discharge, and Hospital Discharge
See text for details.
See this image and copyright information in PMC

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