Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007

• DOI: 10.1007/s00134-010-1914-5
• Publication Date: 2010-05-19T15:54:43Z
• Authors: Paola E. Cogo; Daniele Poole; Daniela Codazzi; Corinne Boniotti; Anna Capretta; Martin Langer; Davide Luciani; Carlotta Rossi; Guido Bertolini
• Keywords: Male; Adolescent; Critical Care; Critical Illness; Infant; Intensive Care Units, Pediatric; 3. Good health; Intensive Care Units; 03 medical and health sciences; Patient Admission; 0302 clinical medicine; Italy; Child, Preschool; Health Care Surveys; Child care; Critically ill children; Delivery of health care; Health care surveys; Intensive care units; Outcome assessment; Adolescent; Child; Child, Preschool; Critical Care; Critical Illness; Female; Health Care Surveys; Humans; Infant; Intensive Care Units, Pediatric; Italy; Male; Prospective Studies; Intensive Care Units; Outcome Assessment (Health Care); Patient Admission; Critical Care and Intensive Care Medicine; Outcome Assessment, Health Care; Child care; Critically ill children; Delivery of health care; Health care surveys; Intensive care units; Outcome assessment; Humans; Female; Prospective Studies; Child

Centralisation of critically ill children to paediatric intensive care units is supported by a strong rationale, but evidence is not overwhelming.To compare the outcome of children admitted to adult intensive care units (ICUs) in Italy between 2003 and 2007 with that of children admitted to paediatric intensive care units (PICUs) in Italy between 1994 and 1995.Prospective, multicenter cohort study and historical controls. Risk of ICU mortality was assessed with the PRISM score in both study and historical control groups. Descriptive statistics, standardized mortality ratios (SMRs) with their 95% confidence intervals, and the calibration plots were reported.A total of 1,265 children admitted to 124 adult ICUs between 2003 and 2007 were compared with an historical control group formed by 1,533 children admitted to 26 PICUs between 1994 and 1995. The PRISM score slightly underestimated hospital deaths for low-risk patients in both groups. The overall SMR was 1.11 (95% CI 0.91-1.31) for adult ICUs and 1.04 (95% CI: 0.88-1.19) for PICUs.The level of care provided nowadays to children admitted to adult ICUs in Italy is similar to that provided by Italian PICUs 10 years earlier. On the other hand, there is evidence that Italian PICUs have improved the level of care in the same period. These findings, if confirmed, suggest a better quality of care for children admitted to PICUs as compared to adult ICUs and support the indication, when possible, of early referral to more specialized units in countries where paediatric intensive care is not centralised.