Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands.
OBJECTIVE
To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality.


METHODS
Retrospective cohort study.


METHODS
Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012.


METHODS
Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included.


METHODS
None.


RESULTS
In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58).


CONCLUSIONS
Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.
1Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands. 2Dutch Pediatric Intensive Care Evaluation, Department of Pediatric Intensive Care, Erasmus Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Radboud University, Nijmegen, The Netherlands. 4Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. 5Department of Pediatric Intensive Care, Academic Hospital Maastricht, The Netherlands. 6Faculty Board Member, PICE Registry, the Netherlands. 7Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 8Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands. 9Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. 10Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands. 11Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands. 12Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. This work was performed at the Department of Pediatric Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Carin W
CW
Verlaat
Idse H
IH
Visser
Nina
N
Wubben
Jan A
JA
Hazelzet
Joris
J
Lemson
Dick
D
van Waardenburg
Douwe
D
van der Heide
Nicolette A
NA
van Dam
Nicolaas J
NJ
Jansen
Mark
M
van Heerde
Cynthia
C
van der Starre
Roelie
R
van Asperen
Martin
M
Kneyber
Job B
JB
van Woensel
Mark
M
van den Boogaard
Johannes
J
van der Hoeven
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors