The Utilization of Critical Care Resources in Pediatric Neurocritical Care Patients.

Autor:	DeSanti RL; Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA., Balakrishnan B; Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI., Rice TB; Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI., Pineda JA; Department of Anesthesiology and Critical Care Medicine, Keck School of Medicine of the University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA., Ferrazzano PA; Department of Pediatrics, University of Wisconsin School of Medicine, American Family Children's Hospital, Madison, WI.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2022 Sep 01; Vol. 23 (9), pp. 676-686. Date of Electronic Publication: 2022 May 27.
DOI:	10.1097/PCC.0000000000002992
Abstrakt:	Objectives: To define the prevalence of neurologic diagnoses and evaluate the utilization of critical care and neurocritical care (NCC) resources among children admitted to the PICU. Design: Retrospective cohort analysis. Setting: Data submitted to the Virtual Pediatric Systems (VPS) database. Patients: All children entered in VPS during 2016 (January 1, 2016, to December 31, 2016). Interventions: None. Measurements and Main Results: There were 128,688 patients entered into VPS and were comprised of 24.3% NCC admissions and 75.7% general PICU admissions. The NCC cohort was older, represented more scheduled admissions, and was more frequently admitted from the operating room. The NCC cohort also experienced a greater decline in prehospitalization to posthospitalization functional status and required more frequent use of endotracheal intubation, arterial lines, and foley catheters but had an overall shorter duration of PICU and hospital length of stay with a higher mortality rate. One thousand seven hundred fifteen patients at 12 participating institutions were entered into a novel, pilot NCC module evaluating sources of secondary neurologic injury. Four hundred forty-eight patients were manually excluded by the data entrant, leaving 1,267 patients in the module. Of the patients in the module, 75.8% of patients had a NCC diagnosis as their primary diagnosis; they experienced a high prevalence of pathophysiologic events associated with secondary neurologic insult (ranging from hyperglycemia at 10.5% to hyperthermia at 36.8%). Conclusions: In children admitted to a VPS-contributing PICU, a diagnosis of acute neurologic disease was associated with greater use of resources. We have identified the most common etiologies of acute neurologic disease in the 2016 VPS cohort, and such admissions were associated with significant decrease in functional status, as well as an increase in mortality. Competing Interests: Dr. Rice received funding from Virtual Pediatric Systems, LLC, as an employee. Dr. Pineda received funding through the St. Louis Children’s Hospital Foundation (PR-2016-190) related to this work. Dr. Ferrazzano receives funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (Award Number R01NS092870) unrelated to this work. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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