Medical Fragility and Inpatient Mortality in a Quaternary Care Pediatric ICU
CCCF ePoster library. Nicoll J. Nov 8, 2018; 234201; 85
Jessica Nicoll
Jessica Nicoll
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Introduction: In developed countries, PICU survival rates exceed 97% with increased survivor disability, hospital readmissions and PICU admissions.1-4  Up to two thirds of PICU patients may have a chronic medical condition.5,6 A subset among these can be characterized as having medical fragility, which encompasses technology dependence, severe neurodevelopmental impairment or three or more chronic medical conditions.7,8 However, the prevalence of medically fragile in PICU and their prognosis after critical illness remains poorly understood.

Objectives: Our objective was to describe the prevalence of device dependent patients and their inpatient mortality during a 14-year period in a quaternary Critical Care Unit

Methods: We conducted a retrospective cohort study using the electronic medical records for all patients born after January 1st, 2001 admitted to the Critical Care Unit (CCU) at the Hospital for Sick Children between 2001 to 2015. We used SAS software (SAS Institute, Toronto, Ontario) to assess the median number of patients per year and overall with each device, inpatient mortality, CCU admissions, CCU and hospital length of stay, ICU patient days and number of admissions per patient.

Results: There were 11 973 patients admitted 17 889 times for 110 573 ICU days. With time, the number of ICU admissions increased and length of stay decreased. The median (IQR) length of stay was 2.8 (1.0-7.9) days. Overall, at time of ICU discharge 315 patients (2.6%) had noninvasive ventilation, 136 (1.1%) had a tracheostomy, 61 (0.5%) had a tracheostomy and were ventilated and 15 (0.1%) were dialyzed. The prevalence of tracheostomy increased with time, and comprised 7408 (6.7%) patient days in the cohort. Inpatient mortality decreased over time. Inpatient mortality was 6.7% overall, 7% in patients with tracheostomy, 5.9% with non-invasive ventilation and 8.2% with a tracheostomy and ventilation.

Conclusion: Device dependent patients comprised a small proportion of ICU admissions, that is increasing with time and is associated with a disproportionate number of ICU days. Inpatient mortality was similar to the entire cohort. A greater understanding of the prognosis of this population after critical illness is important for planning the future of Critical Care.



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