33 - Worsening outcomes in critically ill children with organ dysfunction and complex chronic conditions

Poster Number: 33
Publication Number: 33.102

Crystal M. Chacko, Baylor College of Medicine, Friendswood, TX, United States; Paola Hong Zhu, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, United States; Andrea Marroquin, Baylor College of Medicine, Houston, TX, United States; YASH M. DESAI, Baylor College of Medicine, Austin, TX, United States; Ian Justement, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States; Thomas Fogarty, Baylor College of Medicine, Houston, TX, United States; Jorge Coss-Bu, Baylor College of Medicine, Houston, TX, United States

Background: Complex chronic conditions (CCC) are common in children admitted to the pediatric intensive care unit (PICU). The Pediatric Sequential Organ Failure Assessment (pSOFA) scoring system has been useful in predicting outcome of critically ill children.

Objective: The study aim was to assess the association of CCC and organ dysfunction (OD) of children on admission to the PICU and their outcomes.

Design/Methods: Retrospective study of children admitted (index) to PICU at Texas Children’s Hospital (01/16-12/17) with a length of stay (LOS) in PICU ≥ 3 days. CCC defined by Feudtner, C., BCM Pediatrics 2014. OD defined as a pSOFA score >5 collected on days 1 and 3. Duration of mechanical ventilation (MV), hospital and PICU LOS, risk of mortality (ROM) by PIM2, and mortality were collected.

Results: 1,283 children (729 M/554 F) included, median age 2.83 yr. (0.62-10.4; 25-75th IQR). MV of 143 hr. (79.8-249); PIM2 ROM (%) 3.07 (0.87-4.54); PICU LOS of 6.7 days (4.4-11.3); hospital LOS of 18 days (10-32); pSOFA scores on day 1 & 3 of 5 (4-7) and 5 (3-7) (p < 0.0001, Wilcoxon Signed Rank Test) for a prevalence of OD of 65.71% and 56.82% respectively. The patients with CCC (n=742) represented a prevalence of 57.8% and mortality was 6.9% (n=89). Patients with CCC only (n=246) vs. patients with OD only (n=347) vs. patients with CCC and OD (n=496) vs. patients without CCC or OD (n=194) had: MV hr. 139.5 (74-212) vs. 137 (78.5-215) vs. 163 (82.8-346) vs. 121.5 (74-212) (p=0.0017); PICU LOS, 5.8 days (3.9-9.03) vs. 7.05 (4.7-10.9) vs. 7.8 (4.7-14.2) vs. 5.8 (4-9.04) (p < 0.0001); hospital LOS, 17 days (11-30) vs. 13 (9-26) vs. 23 (13-51) vs. 15 (10-23) (p < 0.0001); and mortality was 2.03% vs. 9.80% vs. 9.68% vs. 1.03% (Chi Square p< 0.0001). On day 1, 58.84% of children with OD had CCC vs. 41.16% without CCC. On day 3, 60.77% of children with OD had CCC vs. 39.23% without CCC. CCC was not associated with OD on day 1 of admission to PICU, odds ratios (OR) (95% CI) of 1.13 (0.89-1.42) (p=0.3134). CCC was associated with OD on day 3 of admission to PICU, OR (95% CI) of 1.32 (1.06-1.65) (p=0.0147).Conclusion(s): Organ dysfunction and complex chronic conditions were common in children admitted to the PICU. Children with complex chronic conditions and organ dysfunction had a longer MV, PICU LOS, hospital LOS, and a higher mortality compared to children without OD and CCC. Children with complex chronic conditions were more likely to have organ dysfunction after admission.