title: Pediatric Intensive Care in PICUs and Adult ICUs: A 2-Year Cohort Study in Finland.
abstract: OBJECTIVE
  To investigate the association between the type of ICU and mortality for children treated at PICUs and adult ICUs.
  
  
  METHODS
  This was a national multicenter cohort study. Data were collected from electronic critical care data management systems at 3 units and from national intensive care registries at 26 units.
  
  
  METHODS
  We assessed the incidence of admissions, length of stay at ICUs, main diagnoses, and mortality for children at ICUs. Units were categorized as PICUs or as adult ICUs located at university hospitals or at non-academic central hospitals.
  
  
  METHODS
  Children younger than 17 years of age treated at ICUs in Finland.
  
  
  METHODS
  Not applicable.
  
  
  RESULTS
  There were 4,876 admissions from 2009 to 2010, and 98.9% of patients survived until unit discharge. The mean length of stay was 3.0 ± 7.4 days; 1,395 patients (35%) required mechanical ventilation at PICUs versus 167 (35%) at adult university hospital ICUs versus 79 (19%) at central hospital ICUs (p < 0.001). The odds for mortality in univariate regression analysis were emergency admission (odds ratio, 3.99; 95% CI, 1.82-8.76), cardiovascular (odds ratio, 7.84; 95% CI, 3.49-22.88), gastrointestinal (odds ratio, 5.37; 95% CI, 1.45-19.88), acute infections (odds ratio, 2.83; 95% CI, 1.23-6.48), hematologic/oncologic disease (odds ratio, 10.32; 95% CI, 3.14-33.86), and nonsurgical trauma (odds ratio, 3.53; 95% CI, 1.19-10.41). Treatment at adult ICUs had higher odds of mortality compared with PICUs (university hospital: odds ratio, 3.93; 95% CI, 1.85-8.35 and central hospital: odds ratio, 3.91; 95% CI, 1.69-9.05), adjusted for readmission less than 48 hours after discharge, emergency admission, mechanical ventilation, and diagnostic group.
  
  
  CONCLUSIONS
  Pediatric patients treated at PICUs showed lower mortality. Requirement of mechanical ventilation, emergency admission, and readmission less than 48 hours after discharge and cardiovascular, gastrointestinal, acute infections, hematologic/oncologic disease, and nonsurgical trauma were associated with higher risk of mortality.
authors.affiliation: 1PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland. 2Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland. 3Department of Anesthesiology, Helsinki University Hospital, Helsinki, Finland. 4Department of Pediatrics, Turku University Hospital, Turku, Finland. 5Division of Intensive Care, Department of Anesthesiology, University of Oulu, Oulu, Finland. 6Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Faculty, University of Oulu, Oulu, Finland.
authors.forename: Outi M
authors.initials: OM
authors.lastname: Peltoniemi
authors.forename: Paula
authors.initials: P
authors.lastname: Rautiainen
authors.forename: Janne
authors.initials: J
authors.lastname: Kataja
authors.forename: Tero
authors.initials: T
authors.lastname: Ala-Kokko
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D012307:Risk Factors