Nupen T L, Argent A C, Morrow B
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2016 Dec 21;107(1):70-75. doi: 10.7196/SAMJ.2016.v107.i1.11279.
Paediatric intensive care is a costly, specialised and limited resource in low- and middle-income countries. The implications of extended paediatric intensive care unit (PICU) stay in South Africa (SA) are not known.
To describe the characteristics, outcomes and resource consumption of long-stay patients (LSPs) and to identify predictive factors for long PICU stay.
A retrospective review of routinely collected data on all children admitted to an SA PICU over one calendar year. Long PICU stay was defined statistically as >19 days. Long- and short-stay patient (SSP) groups were compared, and variables significantly associated with long stay on univariate analysis were entered into a stepwise multiple regression model.
Over the study period, 1 126 children (median age 8 months, 60.9% male) were admitted to the PICU, occupying 5 936 bed-days; 54 LSPs (4.8%) utilised 1 807 (30.4%) bed-days. Mortality and the standardised mortality ratio (actual/mean predicted mortality) in LSPs and SSPs were 29.6% v. 12% (p=0.002) and 2.4 v. 0.7 (p=0.002), respectively. Median duration of stay for LSPs and SSPs was 29.5 days and 2 days, respectively (p<0.0001). LSPs were younger than SSPs (median 4 months (interquartile range 2 - 17) v. 9 months (2 - 34); p=0.03), and fewer were male (48% v. 61.6%, p=0.049). On multivariate analysis, only female gender was independently associated with long PICU stay.
LSPs represent a small proportion of PICU admissions, yet have a higher mortality rate than SSPs and consume disproportionate PICU resources. No predictive model could be established for early recognition of potential LSPs to plan PICU bed allocation effectively.
在低收入和中等收入国家，儿科重症监护是一种成本高昂、专业性强且资源有限的服务。在南非，延长儿科重症监护病房（PICU）住院时间的影响尚不清楚。
描述长期住院患者（LSP）的特征、结局和资源消耗情况，并确定PICU长期住院的预测因素。
对一个日历年内入住南非某PICU的所有儿童的常规收集数据进行回顾性分析。PICU长期住院在统计学上定义为超过19天。比较长期住院和短期住院患者（SSP）组，并将单因素分析中与长期住院显著相关的变量纳入逐步多元回归模型。
在研究期间，1126名儿童（中位年龄8个月，60.9%为男性）入住PICU，占用5936个床日；54名LSP（4.8%）占用1807个（30.4%）床日。LSP和SSP的死亡率及标准化死亡率（实际/平均预测死亡率）分别为29.6%对12%（p=0.002）和2.4对0.7（p=0.002）。LSP和SSP的中位住院时间分别为29.5天和2天（p<0.0001）。LSP比SSP年龄小（中位年龄4个月（四分位间距2 - 17）对9个月（2 - 34）；p=0.03），男性较少（48%对61.6%，p=0.049）。多因素分析显示，只有女性性别与PICU长期住院独立相关。
LSP占PICU入院患者的比例较小，但死亡率高于SSP，且消耗了不成比例的PICU资源。无法建立预测模型以早期识别潜在的LSP，从而有效规划PICU床位分配。
