O'Brien Scott, Nadel Simon, Almossawi Ofran, Inwald David P
1Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.2Pharmacy Department, North Middlesex Hospital NHS Trust, London, United Kingdom.
Pediatr Crit Care Med. 2017 Jan;18(1):1-7. doi: 10.1097/PCC.0000000000000976.
Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40-70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U.K. PICU.
Single-centre retrospective observational cohort study.
Single, tertiary referral PICU.
One thousand one hundred ninety-seven children 0-18 years old admitted between March 1, 2009, and February 28, 2013.
None.
Data were derived from the unit's data submitted to the Paediatric Intensive Care Audit Network, the U.K. national PICU dataset. Data included demographics, diagnosis, Pediatric Index of Mortality-2 score, PICU interventions, PICU outcomes, chronic health condition etiologies, admission, and discharge dates and times. In total, 554 of 1,197 (46.3%) had at least one chronic health condition. Of 554, 371 patients (67.1%) presented with a single chronic health condition, 126 (22.6%) with two chronic health conditions, and 57 (10.3%) with at least three chronic health conditions to a maximum of four chronic health conditions. There was a statistically significant difference in length of stay in those with a chronic health condition compared with those without (medians, 4 vs 3 d [interquartile range, 1-7 d]; Mann-Whitney U test, p < 0.001). The length of stay also increased significantly according to the number of chronic health conditions (Kruskal-Wallis test, p < 0.001). Mortality was significantly different between those with and without chronic health conditions (8.8% vs 5.4%; chi-square test, p = 0.024). Having two or at least three chronic health conditions significantly increased mortality compared with no chronic health conditions (odds ratio, 2.3 [CI, 1.2-4.55]; p = 0.013 and 2.95 [CI, 1.28-6.8]; p = 0.011), respectively.
The increasing number of chronic healthcare conditions is associated with length of stay and mortality.
在英国，每年约有20000名儿童被收入儿科重症监护病房（PICU）。多项国际研究强调，入住PICU的儿童中有40%-70%至少患有一种慢性健康状况，这会导致住院时间延长和死亡率升高。英国PICU收治儿童的慢性健康状况患病率尚不清楚。本研究的目的是利用现有的临床数据，探讨慢性健康状况在一家英国三级PICU中的患病率及其对住院时间和死亡率的影响。
单中心回顾性观察队列研究。
单一的三级转诊PICU。
2009年3月1日至2013年2月28日期间收治的1197名0-18岁儿童。
无。
数据来源于该科室提交给儿科重症监护审核网络（英国国家PICU数据集）的数据。数据包括人口统计学信息、诊断、儿科死亡率指数-2评分、PICU干预措施、PICU结局、慢性健康状况病因、入院和出院日期及时间。在1197名患者中，共有554名（46.3%）至少患有一种慢性健康状况。在这554名患者中，371名（67.1%）患有单一慢性健康状况，126名（22.6%）患有两种慢性健康状况，57名（10.3%）患有至少三种慢性健康状况，最多达四种慢性健康状况。与无慢性健康状况的患者相比，有慢性健康状况的患者住院时间存在统计学显著差异（中位数分别为4天和3天[四分位间距为1-7天]；Mann-Whitney U检验，p<0.001）。住院时间也根据慢性健康状况的数量显著增加（Kruskal-Wallis检验，p<0.001）。有和无慢性健康状况的患者死亡率存在显著差异（8.8%对5.4%；卡方检验，p=0.024）。与无慢性健康状况相比，患有两种或至少三种慢性健康状况显著增加了死亡率（优势比分别为2.3[可信区间为1.2-4.55]；p=0.013和2.95[可信区间为1.28-6.8]；p=0.011）。
慢性健康状况数量的增加与住院时间和死亡率相关。
