Pediatric Intensive Care Outcomes: Development of New Morbidities During Pediatric Critical Care
Pediatric Intensive Care Outcomes: Development of New Morbidities During Pediatric Critical Care
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DOI：
10.1097/pcc.0000000000000250
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发表时间：
2014-11-01
影响因子：
4.1
通讯作者：
Jenkins, Tammara L.
中科院分区：
文献类型：
--
作者：
Pollack, Murray M.;Holubkov, Richard;Jenkins, Tammara L.
目的：研究与儿科重症监护相关的重要新发病率。设计：随机选择，前瞻性队列。设置：来自8个医疗和心脏PICU的PICU患者。患者：这是来自8个医疗和心脏PICU的PICU患者的随机选择，前瞻性队列。测量和主要结果：主要结果指标为出院时功能状态（通过功能状态量表评分测量）和新发发病率（定义为功能状态评分增加）。状态量表大于或等于3。在5，017例患者中，有242例新发疾病（4.8%），99例PICU死亡（2.0%）和120例医院死亡（2.4%）。发病率和死亡率在不同地点之间存在差异（p < 0.001）。最差的功能状态是在PICU出院时，出院时有所改善。出院时，良好分类从基线72%降至63%，轻度异常从10%增至15%，中度异常状态从13%增至14%，重度状态从4%增至5%，极重度不变，为1%。新发病率最高的是神经系统疾病（7.3%）、获得性心血管疾病（5.9%）、癌症（5.3%）和先天性心血管疾病（4.9%）。新的发病率发生在所有年龄段，12个月以下的发病率更高。新的发病率涉及所有功能状态量表领域的最高比例涉及呼吸，运动，喂养dysfunctions.Conclusions：新的发病率的患病率为4.8%，死亡率的两倍，发生在基本上所有类型的患者，在相对平等的比例，并涉及功能的各个方面。与历史数据相比，儿科重症监护有可能将死亡率的改善与发病率的增加相交换。
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.