Multi-institutional Profile of Adults Admitted to Pediatric Intensive Care Units
Multi-institutional Profile of Adults Admitted to Pediatric Intensive Care Units
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DOI：
10.1001/jamapediatrics.2013.1316
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发表时间：
2013-05-01
期刊：
影响因子：
26.1
通讯作者：
Okumura, Megumi J.
中科院分区：
文献类型：
--
作者：
Edwards, Jeffrey D.;Houtrow, Amy J.;Okumura, Megumi J.
重要性：越来越多患有儿童期慢性病的人能够活到成年。许多人使用儿科医院来满足他们的住院需求。据我们所知，成人儿科重症监护病房患者的患病率和特征尚未报道。目的：估计儿童重症监护病房（picu）的成人比例，特征，并将其与年龄较大的青少年进行比较。设计：为期一年的横断面分析。环境：参与虚拟儿科重症监护病房系统的美国儿科重症监护病房。参与者：2008年收治的15岁及以上儿科重症监护室患者。主要结果测量：我们比较了成人和青少年的临床特征和结果。使用混合效应逻辑回归来估计年龄与PICU死亡率的独立关联。结果：picu 70例，入院67629例；1954例（2.7%）患者年龄在19岁或以上；入院9105例（13.5%）患者年龄在15 ~ 18岁。成人（bb0 = 19岁）的比例因PICU而异（范围为0%-9.2%）。随着年龄的增长，患有复杂慢性疾病和计划或围手术期住院的患者比例增加；与创伤相关的入院比例下降。在调整儿科死亡率指数评分、性别、创伤和是否患有复杂慢性疾病后，21 - 29岁患者PICU死亡率比青少年患者高2倍（95% CI, 1.3-3.2； P= 0.004）。年龄在30岁或以上的患者死亡几率高出3.5 （95% CI, 1.3-9.7； P= 0.01）。结论和意义：在这项多机构的研究中，一些picu的成人患者占一小部分但高风险，这表明这些picu应该有专门针对这一群体的计划和方案。
Importance: Growing numbers of persons with childhood-onset chronic illnesses are surviving to adulthood. Many use pediatric hospitals for their inpatient needs. To our knowledge, the prevalence and characteristics of adult pediatric intensive care unit patients have not been reported.Objectives: To estimate the proportion of adults admitted to pediatric intensive care units (PICUs), characterize them, and compare them with older adolescents.Design: One-year cross-sectional analysis.Setting: Pediatric intensive care units in the United States that participated in the Virtual Pediatric Intensive Care Unit Systems.Participants: Pediatric intensive care unit patients 15 years or older admitted in 2008.Main Outcome Measures: We compared adults with adolescents across clinical characteristics and outcomes. Mixed-effects logistic regression was used to estimate the independent association of age with PICU mortality.Results: Seventy PICUs had 67 629 admissions; 1954 admissions (2.7%) were patients 19 years or older; and 9105 admissions (13.5%) were patients aged 15 to 18 years. The proportion of adults (>= 19 years) varied considerably by PICU (range, 0%-9.2%). As age increased, the proportion of patients who had a complex chronic condition and planned or perioperative admissions increased; the proportion of trauma-related admissions decreased. Patients aged 21 to 29 years had a 2 times (95% CI, 1.3-3.2; P=.004) greater odds of PICU mortality compared with adolescent patients, after adjusting for Paediatric Index of Mortality score, sex, trauma, and having a complex chronic condition. Being 30 years or older was associated with a 3.5 (95% CI, 1.3-9.7; P=.01) greater odds of mortality.Conclusions and Relevance: In this multi-institutional study, adults constituted a small but high-risk proportion of patients in some PICUs, suggesting that these PICUs should have plans and protocols specifically focused on this group.