ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2016
PICU Volume and Outcome: A Severity-Adjusted Analysis.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 32 citations in OpenAlex.
- Trial
- The use of machine learning and artificial intelligence within pediatric critical care.Pediatric research · 2023Review
- Outcomes of Children With Firearm Injuries Admitted to the PICU in the United States.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2021Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).Journal of intensive care · 2021Article
- An Assessment of Clinical and System Drivers of Family Satisfaction in the PICU.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Observational
- Article
- Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States.JAMA pediatrics · 2019Observational
- Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study.BMJ paediatrics open · 2019Article
- The impact of body mass index on resource utilization and outcomes of children admitted to a pediatric intensive care unit.SAGE open medicine · 2019Article
- Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults.The New England journal of medicine · 2017Observational
- PICU Volume and Outcome: A Severity-Adjusted Analysis.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).Acute medicine & surgeryArticle
- Provider-Level and Hospital-Level Factors and Process Measures of Quality Care Delivered in Pediatric Emergency Departments.Academic pediatricsArticle
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo determine the relationship between PICU volume and severity-adjusted mortality in a large, national dataset.
designRetrospective cohort study.
settingThe VPS database (VPS, LLC, Los Angeles, CA), a national multicenter clinical PICU database. PATIENTS: All patients with discharge dates between September 2009 and March 2012 and valid Pediatric Index of Mortality 2 and Pediatric Risk of Mortality III scores, who were not transferred to another ICU and were seen in an ICU that collected at least three quarters of data.
interventionsNone. MEASUREMENTS AND MAIN
resultsAnonymized data received included ICU mortality, hospital and patient demographics, and Pediatric Index of Mortality 2 and Pediatric Risk of Mortality III scores. PICU volume/quarter was determined (VPS sites submit data quarterly) per PICU and was divided by 100 to assess the impact per 100 discharges per quarter (volume). A mixed-effects logistic regression model accounting for repeated measures of patients within ICUs was performed to assess the association of volume on severity-adjusted mortality, adjusting for patient and unit characteristics. Multiplicative interactions between volume and severity of illness were also modeled. We analyzed 186,643 patients from 92 PICUs, with an overall ICU mortality rate of 2.6%. Volume ranged from 0.24 to 8.89 per ICU per quarter; the mean volume was 2.61. The mixed-effects logistic regression model found a small but nonlinear relationship between volume and mortality that varied based on the severity of illness. When severity of illness is low, there is no clear relationship between volume and mortality up to a Pediatric Index of Mortality 2 risk of mortality of 10%; for patients with a higher severity of illness, severity of illness-adjusted mortality is directly proportional to a unit's volume.
conclusionsFor patients with low severity of illness, ICU volume is not associated with mortality. As patient severity of illness rises, higher volume units have higher severity of illness-adjusted mortality. This may be related to differences in quality of care, issues with unmeasured confounding, or calibration of existing severity of illness scores.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.