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Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score

BACKGROUND: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the...

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Autores principales: Knaup, Emily, Nosaka, Nobuyuki, Yorifuji, Takashi, Tsukahara, Kohei, Naito, Hiromichi, Tsukahara, Hirokazu, Nakao, Atsunori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664501/
https://www.ncbi.nlm.nih.gov/pubmed/31384469
http://dx.doi.org/10.1186/s40560-019-0392-2
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author Knaup, Emily
Nosaka, Nobuyuki
Yorifuji, Takashi
Tsukahara, Kohei
Naito, Hiromichi
Tsukahara, Hirokazu
Nakao, Atsunori
author_facet Knaup, Emily
Nosaka, Nobuyuki
Yorifuji, Takashi
Tsukahara, Kohei
Naito, Hiromichi
Tsukahara, Hirokazu
Nakao, Atsunori
author_sort Knaup, Emily
collection PubMed
description BACKGROUND: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission. METHODS: We performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017. RESULTS: Overall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%). An 11-variable simple predictive scoring system was constructed, including Pediatric Index of Mortality 2 ≥ 1 (2 points), liver dysfunction (non-post operation) (2 points), post-cardiopulmonary resuscitation (1 point), circulatory disorder (1 point), post-operative management of liver transplantation (1 point), encephalitis/encephalopathy (1 point), myocarditis/cardiomyopathy (1 point), congenital heart disease (non-post operation) (1 point), lung tissue disease (1 point), Pediatric Cerebral Performance Category scores ≥ 2 (1 point), and age < 2 years (1 point). A score of ≥ 3 points yielded an area under the receiver operating characteristic curve (AUC) of 0.79, sensitivity of 87.0%, and specificity of 59.4% in the original dataset. Reproducibility was confirmed with the internal validation dataset (AUC 0.80, sensitivity 92.6%, and specificity 60.2%). CONCLUSIONS: Pediatric LSPs possess a significant presence in Japanese ICUs with high rates of bed utilization and mortality. The newly developed predictive scoring system may identify pediatric LSPs on admission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0392-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-66645012019-08-05 Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score Knaup, Emily Nosaka, Nobuyuki Yorifuji, Takashi Tsukahara, Kohei Naito, Hiromichi Tsukahara, Hirokazu Nakao, Atsunori J Intensive Care Research BACKGROUND: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission. METHODS: We performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017. RESULTS: Overall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%). An 11-variable simple predictive scoring system was constructed, including Pediatric Index of Mortality 2 ≥ 1 (2 points), liver dysfunction (non-post operation) (2 points), post-cardiopulmonary resuscitation (1 point), circulatory disorder (1 point), post-operative management of liver transplantation (1 point), encephalitis/encephalopathy (1 point), myocarditis/cardiomyopathy (1 point), congenital heart disease (non-post operation) (1 point), lung tissue disease (1 point), Pediatric Cerebral Performance Category scores ≥ 2 (1 point), and age < 2 years (1 point). A score of ≥ 3 points yielded an area under the receiver operating characteristic curve (AUC) of 0.79, sensitivity of 87.0%, and specificity of 59.4% in the original dataset. Reproducibility was confirmed with the internal validation dataset (AUC 0.80, sensitivity 92.6%, and specificity 60.2%). CONCLUSIONS: Pediatric LSPs possess a significant presence in Japanese ICUs with high rates of bed utilization and mortality. The newly developed predictive scoring system may identify pediatric LSPs on admission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0392-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-29 /pmc/articles/PMC6664501/ /pubmed/31384469 http://dx.doi.org/10.1186/s40560-019-0392-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Knaup, Emily
Nosaka, Nobuyuki
Yorifuji, Takashi
Tsukahara, Kohei
Naito, Hiromichi
Tsukahara, Hirokazu
Nakao, Atsunori
Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title_full Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title_fullStr Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title_full_unstemmed Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title_short Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score
title_sort long-stay pediatric patients in japanese intensive care units: their significant presence and a newly developed, simple predictive score
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664501/
https://www.ncbi.nlm.nih.gov/pubmed/31384469
http://dx.doi.org/10.1186/s40560-019-0392-2
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