title: Epidemiology of Pediatric Critical Illness in a Population-Based Birth Cohort in Olmsted County, MN.
abstract: OBJECTIVE
  Investigations of pediatric critical illness typically focus on inpatient cohorts drawn from wide referral areas and diverse healthcare systems. Cohorts amenable to investigating the full spectrum of critical illness as it develops within a community have yet to be studied in the United States. Our objective was to provide the first epidemiologic report of the incidence and presentation of pediatric critical illness within a U.S. population-based birth cohort.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A geographically defined community (Olmsted, MN) with medical record linkage across all health systems. All ICU services are provided within a single children's hospital.
  
  
  METHODS
  A birth cohort of children (n =9,441) born 2003-2007 in Olmsted County, MN.
  
  
  RESULTS
  During the study period, there were a total of 15,277 ICU admissions to Mayo Clinic Children's Hospital. A total of 577 birth cohort children accounted for 824 of these admissions during the 61,770 person-years of follow-up accumulated. Incidence of first-time ICU admission was 9.3 admits per 1,000 person-years. Admission rates were highest in the first year of life and then declined steadily. Respiratory problems were among the most common reasons for admission at any age and diagnoses reflect changes in health risk factors as children grow and develop over time. After 1 year old, a majority of children admitted have preexisting chronic comorbidities and/or prior ICU stays. In-hospital mortality occurred exclusively in children admitted prior to 5 days of age (n = 4). Seven children died after hospital discharge.
  
  
  CONCLUSIONS
  This is the first report characterizing critical illness within a population-based birth cohort of U.S. children. The results demonstrate the changing incidence, presentation, and healthcare requirements associated with critical illness across the developmental spectrum as a population of children ages.
authors.affiliation: 1Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Department of Health Services Research, Mayo Clinic College of Medicine, Rochester, MN. 2Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN. 3Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN. 4Department of Epidemiology and Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN. 5Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN. 6Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN. 7Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN. 8Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Sheri S
authors.initials: SS
authors.lastname: Crow
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Undavalli
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: Slavica K
authors.initials: SK
authors.lastname: Katusic
authors.forename: Pujan
authors.initials: P
authors.lastname: Kandel
authors.forename: Sinead L
authors.initials: SL
authors.lastname: Murphy
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: R Scott
authors.initials: RS
authors.lastname: Watson
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D053208:Kaplan-Meier Estimate; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D012189:Retrospective Studies