Analyzing Mortality Trends in the UK Pediatric Critical Care Long-Stay Patient Cohort

Abstract

Abstract Long-stay patients in pediatric intensive care unit (PICU) are at risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counseling and support. We aim to analyze the factors associated with higher mortality in the long-stay PICU patient cohort. Retrospective single-center study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a 3-year study period (April 1, 2017–March 31, 2020). Outcomes analyzed included in-PICU mortality and mortality within 12 months of PICU discharge. Variables analyzed for association with outcomes included primary diagnostic category, number and nature of additional comorbidities, long-term ventilation (LTV) pathway, etc. During a 3-year period, there were 2,848 unique individual patient admissions to the PICU; 165 children had 172 long-stay admissions. The overall in-PICU mortality of long-stay patient was 30.2% compared with 6.4% ( p  < 0.0001) for whole PICU population; 42% of the long-stay patients had died by 12 months postdischarge. Certain primary diagnostic groups, for example, hematology/oncology, had a statistically significant increased likelihood of death (odds ratio [OR] 8.6 [ p  = 0.004, confidence interval, CI, 2.0–39.5]). Children on an LTV pathway had relatively lower odds of death (OR 0.1 [ p  = 0.003, CI 0.01–0.34]). We described factors associated with higher and lower mortality rates in a group of long-stay PICU patients. Understanding the impact of specific combinations of factors as shown in this analysis on outcomes may be important for clinicians to help counsel families.