Children with Chronic Illness Return to Their Baseline Functional Status after Organ Dysfunction on the First Day of Admission in the Pediatric Intensive Care Unit

Objective

To determine chronic illness outcomes after admission with multiple organ dysfunction syndrome (MODS) for patients in the pediatric intensive care unit (PICU).

Study design

We evaluated consecutive PICU admissions from 35 US children's hospitals from January 2004–December 2005 in the virtual PICU Performance System database. We excluded hospitals with >10% missing values for MODS variables and patients < 1 month or > 18 years of age. MODS was identified by laboratory and vital sign values from day of admission with International Pediatric Sepsis Consensus Conference criteria. Chronic illness was identified by secondary diagnoses, classified by modified Delphi method. We evaluated functional outcomes with pediatric overall performance category and pediatric cerebral performance category scores from PICU admission and discharge.

Results

Of 44 693 admissions, 52.1% had a chronic diagnosis. Chronic diagnoses increased MODS at PICU admission (24.6% vs 12.0%, P < .001) and mortality rates (3.7% vs 1.9%, P < .001). Patients with a chronic diagnosis had similar changes in pediatric overall performance category and pediatric cerebral performance category scores from PICU admission to discharge as previously healthy children. However, outcome in different chronic diagnosis categories was variable.

Conclusions

Chronic illness increased MODS incidence at PICU admission and impacted all-cause PICU mortality rates. Although, in aggregate, children who survive return to baseline functional status, this varies by chronic illness category.

MODS, Multiple organ dysfunction syndrome, OR, Odds ratio, PCPC, Pediatric Cerebral Performance Category, PICU, Pediatric intensive care unit, PIM2, Pediatric Index of Mortality 2, POPC, Pediatric Overall Performance Category, PRISM, Pediatric Risk of Mortality, VPS, VPICU Performance System