Abstract |
Background: Pediatric critical care has evolved over the past 3 decades, mainly with the
evolution of technology and subspecialties. The doctors who staff a Pediatric Intensive Care
Unit (PICU) are experienced specialized intensivists in children and the nursing staff working
in a PICU has expertise and special knowledge on the subject. The provision of care in all PICUs,
versatile general or specialized, aim at the best and most efficient treatment of seriously ill
pediatric patients and at dealing with critical situations, which often appear unexpectedly.
Objective. : The purpose of this study is to collect the epidemiological data of pediatric
patients who were hospitalized in a University Children's ICU, to study the longitudinal trends
and to correlate them with outcome indicators.
Methods. The study was conducted in the PICU of the University General Hospital of
Heraklion. Data were collected retrospectively from electronic health records of patients
hospitalized between May 2014 and December 2022. Demographics, clinical information,
therapeutic interventions, in-hospital complications, length of hospital stay, final diagnosis
and patient outcome indicators were recorded.
Results: For the studied period of time, 1332 patients were hospitalized in the PAGNI
Children's ICU, while complete data were found for 1250 patients. Median age was 5.7 years
(IQR 1.6;11.75), boys were 769 (61.5%), PIM-III clinical severity index was -2.5 (-4.2; -0.8),
comorbidity was 543 (43.4%), while hospitalized 14 cases of Covid-19. 957 (76.6%) patients
were pathological cases, while 293 (23.4%) were surgical, with 128/293 (43.7%) being trauma
or accident. Planned admissions were 408 (32.6%) [307/408 (75.2%) pathological cases,
101/308 (24.8%) surgical cases]; medical versus surgical patients differed in terms of reason
for admission, age and length of stay (p<0.001). Emergency admissions were 842 (67.4%)
[650/842 (77.2%) pathological cases, 192/842 (22.8%) surgical cases]. The average length of
hospitalization did not significantly vary over time and ranged from 4.4 to 9.3 days. Disease
severity varied over time (p<0.001), with patients who died having a greater severity of illness
(p<0.001). Mechanical ventilation was applied to 398 (47.3%) patients, with a statistically
significant difference over time (p=0.044). Emergency admissions differed significantly from
planned admissions in terms of reason for admission, clinical severity, GCS, use of catheters,
administration of antibiotics, ICU and hospital length of stay, and mortality (all p<0.001), but
not for age, BMI and gender. Crude mortality was estimated at 5.7% (N=48/842) and remained stable over time with a range of 2.5%–6.9%. It was significantly related to comorbidity and the
presence of cerebral edema (all, p<0.001). Independent factors associated with mortality
were clinical severity, shock and low GCS at admission (p<0.001). Disease severity,
comorbidity, respiratory failure, and low GCS were good predictors of mortality (all p<0.001).
Of the surviving patients, 421 (50%) had a very good outcome and recovery, 315 (37.4%) were
discharged from the NICU receiving some chronic treatment, such as chronic drug therapy
(N=160), feeding through indwelling catheters (N= 88), oxygen therapy (N=145), ventilator
support (N=25 via tracheostomy, N=6 with non-invasive mechanical ventilation).
Conclusion: The present study is the first description of longitudinal trends and 9-year
epidemiological data of pediatric patients admitted to the PICU in Greece. The planned
admissions constitute a sufficient number of patients, which justifies the development of a
specific infrastructure and the exclusive employment of specialized nursing and medical staff.
The significant majority of patients admitted to the ICU were on an emergency basis. Over
time, the average length of hospital stay and mortality remained stable. Mortality was related
to clinical severity, shock, impaired level of consciousness and underlying complex co-
morbidity. Surviving patients had high rates of morbidity and this signals the need for the
development of ongoing follow up facilities with early recognition and holistic treatment of
physical and psychosocial problems.
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