Children with chronic illness return to their baseline functional status after organ dysfunction on the first day of admission in the pediatric intensive care unit

Abstract

Objective: To determine chronic illness outcomes after admission with multiple organ dysfunction syndrome (MODS) for patients in the pediatric intensive care unit (PICU).

Study design: We evaluated consecutive PICU admissions from 35 US children's hospitals from January 2004-December 2005 in the virtual PICU Performance System database. We excluded hospitals with >10% missing values for MODS variables and patients<1 month or>18 years of age. MODS was identified by laboratory and vital sign values from day of admission with International Pediatric Sepsis Consensus Conference criteria. Chronic illness was identified by secondary diagnoses, classified by modified Delphi method. We evaluated functional outcomes with pediatric overall performance category and pediatric cerebral performance category scores from PICU admission and discharge.

Results: Of 44 693 admissions, 52.1% had a chronic diagnosis. Chronic diagnoses increased MODS at PICU admission (24.6% vs 12.0%, P<.001) and mortality rates (3.7% vs 1.9%, P<.001). Patients with a chronic diagnosis had similar changes in pediatric overall performance category and pediatric cerebral performance category scores from PICU admission to discharge as previously healthy children. However, outcome in different chronic diagnosis categories was variable.

Conclusions: Chronic illness increased MODS incidence at PICU admission and impacted all-cause PICU mortality rates. Although, in aggregate, children who survive return to baseline functional status, this varies by chronic illness category.

Figure 1

Data management algorithm VPS= VPICU Performance System; SBP=systolic blood pressure; POPC= Pediatric Overall Performance Category; PCPC=Pediatric Cerebral Performance Category; PRISM=Pediatric Risk of Mortality

Figure 2

Baseline and change of functional outcome scores from PICU admission to discharge by presence of chronic diagnoses POPC= Pediatric Overall Performance Category; PCPC=Pediatric Cerebral Performance Category; PICU=Pediatric Intensive Care Unit; Chronic Diagnosis -= No chronic diagnosis identified; Chronic Diagnosis += At least one chronic diagnosis identified; DeltaPOPC= DischargePOPC-BaselinePOPC; DeltaPCPC=DischargePCPC-BaselinePCPC. ^aPatients with chronic diagnoses had higher baseline POPC and PCPC scores (p<0.001) at PICU admission. ^bPatients with chronic diagnoses had greater (worse) changes in POPC and PCPC scores from PICU admission to discharge (Mann Whitney rank sum, p<0.001). These differences did not appear clinically significant.

Figure 3

Prevalence and Type of Chronic Diagnoses in the Pediatric Intensive Care Unit Chronic Diagnosis -= No chronic diagnosis; Chronic Diagnosis += At least one chronic diagnosis; Neuro=Neurologic diagnosis; GI= Gastrointestinal diagnosis; Heme/onc= Hematologic or oncologic diagnosis. *Subgroups of chronic diagnoses which represent combined categories. Transplant category represents both solid organ and bone marrow transplant. Heme/Onc represents both hematologic and oncologic diagnoses. Cardiac subgroup represents both congenital and acquired cardiac disease. Other category includes rheumatologic, endocrine, orthopedic, psychiatric, former premature birth.