Epidemiology of long-stay patients in the pediatric intensive care unit: prevalence, characteristics, resource consumption and complications

Abstract

Background: The impact of pediatric intensive care unit (PICU) utilization and resource consumption among long-stay patients has not been characterized recently. This study aimed to describe the resource consumption and characteristics of long-stay patients in a PICU.

Methods: This was a single-center descriptive cohort study of 1309 patients admitted to a PICU in 2017. The main outcome was ICU length of stay (LOS). Patients were divided into prolonged LOS (PLS) and non-PLS groups if they had an LOS of ≥ 28 or < 28 days, respectively. Two groups were compared to characterize PLS.

Results: Thirty-two (2.4%) patients had a PLS and utilized 33% of PICU bed days. Factors associated with PLS with odds ratio [95% confidence interval (CI)] were being a neonate (7.8 [2.5-25.4], p = <0.001), being an infant (2.9 [1.0-9.0], p = 0.04), admission for a respiratory ailment (7.3 [1.6-44.2], p = 0.003), cardiovascular dysfunction (24.1 [4.8-152.1], p = <0.001), post-cardiac operation (8.0 [1.7-50.1], p = 0.003), post-cardiopulmonary arrest (22.8 [1.7-211.9], p = 0.01), and transfer from another facility (4.2 [1.8-10.7], p = 0.001). PLS patients developed more nosocomial infections and disproportionately received monitoring and therapeutic resources.

Conclusions: A PLS was associated with substantial PICU utilization and complication rates. Future studies should aim to alleviate both institutional and patient-related issues in the affected population harboring possible risk factors for PLS.

Keywords: Complication; Long stay; Pediatric intensive care; Resource utilization; Risk factor.

Fig. 1

Pediatric intensive care unit (PICU) utilization by percentage of admissions (left) bed days (right). Note that 2.4% of patients with a length of stay (LOS) ≥ 28 days accounted for 33.0% of the overall ICU bed days. The combined 5.9% of patients with an LOS ≥ 28 or 14–27 days accounted for 47% of bed days, whereas the 69.4% of patients with an LOS of < 3 days and 17.7% of patients with an LOS of 3–6 days accounted for 19.3% and 17.9% of ICU bed days, respectively.

Fig. 2

Frequencies of device, treatment, and surgical intervention usage among patients stratified by length of stay. The frequencies of utilization in categories such as arterial line, central venous line, Foley catheter, vasoactive drug, and mechanical ventilation increased as the length of stay was prolonged (a). However, RRT, ECMO, tracheostomy, and gastrostomy were predominantly applied to patients with a length of stay ≥ 14 days (b). A line, arterial line; CV line, central venous line; MV, mechanical ventilation; RRT, renal replacement therapy; ECMO, extracorporeal membrane oxygenation. Foley*: Foley catheter

Fig. 3

Mean length of stay according to PIM-2 (pediatric risk of mortality) category. A positive correlation was observed between a PIM-2 of 0–6% and the length of stay, whereas the length of stay decreased at higher PIM-2 values

Fig. 4

Percentages of patients in five length-of-stay categories, stratified by age. Neonates comprised a considerable proportion of patients with a prolonged length of stay, whereas only a few pre-school and school-aged patients had stays > 14 days

Fig. 5

Percentages of patients in five length-of-stay categories, stratified by admission category. Patients admitted for respiratory or cardiovascular dysfunction, post-cardiac arrest, and cardiac surgery had substantially longer lengths of stay than non-cardiac surgical patients. PCAS, post-cardiopulmonary arrest

Fig. 6

Percentages of patients in five length-of-stay categories, stratified by origin of admission. Although the majority of patients admitted from the operation room and emergency room stayed for < 7 days, a considerable percentage of patients transferred from other hospitals and wards stayed for ≥ 14 days. ER, emergency room; OR, operation room