Prevalence of Children With Complex Chronic Conditions in PICUs of Argentina: A Prospective Multicenter Study.

OBJECTIVES: To determine the prevalence of children with complex chronic conditions in PICUs in Argentina. To describe the demographic profile, clinical course and outcomes in PICU of children with complex chronic condition in comparison to previously healthy children. DESIGN: Prospective, observational multicenter study. SETTING: Nineteen PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children admitted to the participating PICUs between March 1, 2015, and February 28, 2016. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: We analyzed 3,483 PICU admissions. The prevalence of complex chronic condition was 48.06% (95% CI, 46.39-49.72). Cardiovascular complex chronic condition was predominant (22.24% [421/1,893]), followed by neuromuscular complex chronic condition (18.75% [355/1,893]) and malignant disease 17.7% (335/1,893). Technologic dependence was present in 22.22% of the patients (372 of 1,674). Predominant admission diagnosis was postoperative (36.6%) and respiratory disease (28.32%). Children with complex chronic condition had higher mortality than previously healthy patients (odds ratio, 2.74; 95% CI, 2.01-3.73). The risk of prolonged stay (≥ 26 d) was also higher (odds ratio, 1.44; 95% CI, 1.10-1.89). Rate utilization of the following devices was higher in patients with complex chronic condition: mechanical ventilation (odds ratio, 1.35; 95% CI, 1.12-1.63), central venous catheter (odds ratio, 1.24; 95% CI, 1.04-1.48), and arterial monitoring (odds ratio, 1.33; 95% CI, 1.09-1.63). CONCLUSIONS: We observed a high prevalence of patients with complex chronic condition in this sample of argentine PICUs. These patients presented higher mortality and resource use than previously healthy children. This information is valuable to understand the impact that patients with complex chronic condition have on PICU performance and enables proper planning of care.

Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study.

OBJECTIVE: To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina. DESIGN: Prospective, national, multicenter study. SETTING: Forty-nine PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children between 1 month and 16 years old admitted to the participating PICUs between May 15, 2016, and February 15, 2017. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A total of 6,602 patients were enrolled in the study. The observed mortality was 8% (531/6,602), whereas mortality predicted by Pediatric Index of Mortality 3 was 6.16% (407 deaths). The standardized mortality rate was 1.3 (95% CI, 1.20-1.42). The area under the receiver operating characteristic curve was 0.83 (95% CI, 0.82-0.85). The Hosmer-Lemeshow test showed that the difference between the mortality observed and the mortality predicted by Pediatric Index of Mortality 3 was statistically significant (χ, 135.63; p < 0.001). CONCLUSIONS: The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.