Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

AIMS: To determine whether the paediatric intensive care (PIC) population weight distribution differs from the UK reference population and whether weight-for-age at admission is an independent risk factor for mortality. METHODS: Admission weight-for-age standard deviation scores (SDS) were calculated for all PIC admissions (March 2003–December 2011) to Great Ormond Street Hospital: this is the number of standard deviations (SD) between a child’s weight and the UK mean weight-for-age. Categorised into nine SDS groups, standardised mortality ratios (SMR) and logistic regression were used to assess the relationship between weight-for-age at admission and risk-adjusted mortality. RESULTS: Out of 12,458 admissions, mean weight-for-age was 1.04 SD below the UK reference population mean (p < 0.0001). Based on 942 deaths, risk-adjusted mortality was lowest in those with mild-to-moderately raised weight-for-age (SDS 0.5–2.5) and highest in children with extreme under- or overweight (SDS < −3.5 and SDS > +3.5). Logistic regression indicated that age, gender, ethnicity and weight-for-age are independent risk factors for mortality. South Asian and ‘other’ ethnicities had significantly increased risk of death compared to children of white and black ethnic origin. CONCLUSION: The PIC population mean weight-for-age is significantly lower than the UK reference mean. The extremes of weight-for-age are over-represented, especially underweight. Weight-for-age at admission is an independent risk factor for mortality. A U-shaped association between weight and risk-adjusted mortality exists, with the lowest risk of death in children who are mild-to-moderately overweight. Future studies should determine the impact of malnutrition on risk-adjusted mortality and investigate the aetiology of risk disparities with ethnicity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-014-3381-x) contains supplementary material, which is available to authorized users.