Department of Paediatric Intensive Care Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2022 Nov 1;23(11):919-928. doi: 10.1097/PCC.0000000000003060. Epub 2022 Aug 29.
To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs).
A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018.
Population-based study in ANZ.
A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded.
None.
The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions).
Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.
描述澳大利亚和新西兰（ANZ）儿科重症监护集中化程度的区域差异和时间变化，并比较接受专科 PICU 和普通 ICU（GICU）治疗的儿童的特征和 ICU 死亡率。
使用 2003-2005 年和 2016-2018 年两个 ICU 入院阶段的登记数据进行回顾性队列研究。
ANZ 的基于人群的研究。
共纳入 43256 名年龄小于 16 岁的 ICU 入院患儿。不包括 28 天以下无心脏疾病的婴儿。
无。
主要结局是风险调整后的 ICU 死亡率。使用逻辑回归调查死亡率与 ICU 类型、时期暴露以及它们之间的相互作用的关系。与 GICU 入院的患儿相比，PICU 入院的患儿年龄更小（中位数 25 个月 vs 47 个月；p<0.01），在 ICU 停留时间更长（中位数 1.6 天 vs 1.0 天；p<0.01）。在整个研究中，澳大利亚 93%的入院患儿被收入 PICU，而新西兰只有 63%的入院患儿被收入 PICU。与第一阶段相比，第二阶段的死亡调整后比值比（AOR）降低（AOR，0.50；95%CI，0.42-0.59）。单位类型和时期之间存在交互作用，与第二阶段 GICU 治疗相关的死亡几率增加（AOR，1.63；95%CI，所有入院患者为 1.05-2.53；高危入院患者为 1.73，CI，1.002-3.00）。
在 14 年的研究期间，接受专科 PICU 治疗的患儿的风险调整死亡率下降；然而，在接受 GICU 治疗的高危患儿中，时间与结局之间没有类似的关联。研究结果支持为危重症患儿提供集中化重症监护的持续使用。
