Pediatric Intensive Care Utilization and Outcomes in Denmark.

Importance: Population-based estimates of the incidence of children admitted to intensive care units (ICUs) in Denmark, including ICU admission patterns over time, are limited. Objectives: To determine how ICU admission, treatment patterns, characteristics, and outcomes of critically ill children have changed between 2019 and 2024. Design, Setting, and Participants: This population-based, retrospective cohort study included data from 19 public Danish hospitals from 2019 to 2024.Pediatric ICU patients (aged 0-17 years) were included. Admissions to neonatal ICUs, rehabilitation centers, or psychiatric hospitals were excluded. Exposure: Admission to an ICU. Main Outcomes and Measures: Data from Danish registers included demographics, diagnoses, ICU interventions, ICU outcomes, and date and time of admission and discharge. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to identify diagnoses and comorbidities. Poisson regression was used to evaluate ICU admission and mortality rates, with the log of the annual number of children in Denmark at risk included as an offset. Results: The study included 7875 children representing 9458 ICU admissions (median [IQR] age, 6 [1-13] years; 5533 [58.5%] male). Patients with chronic comorbidity accounted for 4918 admissions (52.0%), with congenital malformations being the most common comorbidity (2973 [31.4%]). From 2020 to 2024, the incidence of pediatric hospital admissions decreased from 109.12 (95% CI, 109.12-109.12) per 1000 person-years to 93.79 (95% CI, 93.79-93.79) per 1000 person-years (incidence rate ratio [IRR], 0.86; 95% CI, 0.86-0.86). The incidence of ICU admissions decreased from 1.35 (95% CI, 1.35-1.35) per 1000 person-years to 1.17 (95% CI, 1.17-1.17) per 1000 person-years (IRR, 0.86; 95% CI, 0.86-0.86). Overall all-cause mortality of pediatric ICU patients remained similar (ranging between 50 and 71 [2.9% and 4.4% of all pediatric admissions at an ICU]), as did in-hospital mortality (ranging from 30 to 44 [1.8% to 2.7%]) and 30-day post-discharge mortality (ranging from 17 [1.1%] to 33 [2.1%]). Findings were consistent in sensitivity analyses using 2022 as a post-COVID-19 pandemic reference year. Conclusions and Relevance: In this cohort study of 7875 children representing 9458 ICU admissions in Denmark, ICU admission rates declined during the study period from 2019 to 2024 and remained a small proportion of overall pediatric hospitalizations. In-hospital and postdischarge mortality remained stable and low.