title: Pediatric rheumatic disease in the intensive care unit: lessons learned from 15 years of experience in a tertiary care pediatric hospital.
abstract: OBJECTIVE
  This study describes the 15-yr experience of a large urban tertiary care children's hospital in treating critically ill patients with pediatric rheumatic diseases.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Children's Hospital Los Angeles, a large urban tertiary care children's hospital.
  
  
  METHODS
  All patients with pediatric rheumatic diseases admitted to the Children's Hospital Los Angeles pediatric intensive care unit from January 1995 to July 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  An internal database and medical records were reviewed for demographics, diagnoses, treatments, organ dysfunction, interventions, infections, and outcomes. Standardized mortality ratio was calculated based on Pediatric Risk of Mortality III estimated mortality. Factors associated with mortality were identified by univariate analyses.Ninety patients with 122 total admissions were identified. The majority of patients were Hispanic (63%), female (73%), and had systemic lupus erythematosus (62%). Pediatric rheumatic disease-related complications (50%) were the most common reason for admission; 32% of admissions involved multiorgan dysfunction. Eighteen admissions (15%) resulted in mortality. Deaths were most commonly attributed to combined infection and active rheumatic disease (50%), infection only (22%), rheumatic disease only (11%), or other causes (17%). In 30 (25%) admissions, a new rheumatologic diagnosis was established. Standardized mortality ratio was 0.72 (95% confidence interval 0.38-1.25) for pediatric rheumatic disease patients compared to 0.87 (95% confidence interval 0.79-0.96) for all pediatric intensive care unit patients. Factors associated with mortality included use of mechanical ventilation, vasopressors, and renal replacement (continuous venovenous hemodialysis) (all p < .05).
  
  
  CONCLUSIONS
  Pediatric rheumatic disease-related complications were the principal cause of pediatric intensive care unit admission. Deaths occurred most often from severe infections in patients with active rheumatic disease. Pediatric rheumatology patients admitted to the pediatric intensive care unit had outcomes similar to the global pediatric intensive care unit population when adjusted for severity of illness.
authors.affiliation: Division of Rheumatology, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. suhas@post.harvard.edu
authors.forename: Suhas M
authors.initials: SM
authors.lastname: Radhakrishna
authors.forename: Andreas O
authors.initials: AO
authors.lastname: Reiff
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Marzan
authors.forename: Colleen
authors.initials: C
authors.lastname: Azen
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
authors.forename: Sarah
authors.initials: S
authors.lastname: Rubin
authors.forename: Jondavid
authors.initials: J
authors.lastname: Menteer
authors.forename: Diane E
authors.initials: DE
authors.lastname: Brown
authors.forename: Bracha
authors.initials: B
authors.lastname: Shaham
mesh_terms: D000293:Adolescent; D002648:Child; D003422:Critical Care; D005260:Female; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D015141:Los Angeles; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome