A5017318882- Sepsis Diagnosis and Treatment
- Emergency and Acute Care Studies
- Respiratory Support and Mechanisms
- Cardiac Arrest and Resuscitation
- Neonatal Respiratory Health Research
- Hemodynamic Monitoring and Therapy
- Mechanical Circulatory Support Devices
- Cardiac, Anesthesia and Surgical Outcomes
- Family and Patient Care in Intensive Care Units
- Healthcare Policy and Management
- Childhood Cancer Survivors' Quality of Life
- Trauma and Emergency Care Studies
- Infant Development and Preterm Care
- Renal function and acid-base balance
- Intensive Care Unit Cognitive Disorders
- Patient Safety and Medication Errors
- Palliative Care and End-of-Life Issues
- Child and Adolescent Health
- Congenital Heart Disease Studies
- Respiratory viral infections research
- Pneumonia and Respiratory Infections
- Healthcare cost, quality, practices
- Clinical Nutrition and Gastroenterology
- Airway Management and Intubation Techniques
- Disaster Response and Management
Children's National
2016-2025
George Washington University
2014-2025
Children's Hospital of Philadelphia
2011-2024
University of Pennsylvania
2019-2024
Philadelphia University
2019-2024
Children's Hospital Colorado
2023
University of Colorado Denver
2023
Chan Zuckerberg Initiative (United States)
2023
Nationwide Children's Hospital
2021
University of Pittsburgh
2021
Objectives The relationship between physiologic status and mortality risk should be reevaluated as new treatment protocols, therapeutic interventions, monitoring strategies are introduced, patient populations change. We developed validated a third-generation pediatric physiology-based score for risk, Pediatric Risk of Mortality III (PRISM III). Design Prospective cohort. Setting There were 32 intensive care units (ICUs): 16 ICUs randomly chosen volunteered. Patients Consecutive admissions at...
The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce number physiologic variables required for pediatric ICU (PICU) mortality risk assessment and obtain an objective weighting remaining variables. Univariate multivariate statistical techniques were applied admission day PSI data (1,415 patients, 116 deaths) four PICUs. resulting PRISM consists 14 routinely measured, variables, 23 variable ranges. performance a logistic function...
The goal was to create a functional status outcome measure for large studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable hospitalized pediatric patients across wide range of ages inpatient environments.Functional Status Scale (FSS) domains functioning included mental status, sensory functioning, communication, motor feeding, respiratory categorized from normal (score = 1) very severe dysfunction 5). Adaptive Behavior...
Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but complicated by bleeding thrombosis.(1) To measure the incidence of (blood loss requiring transfusion or intracranial hemorrhage) thrombosis during ECMO support; (2) to identify factors associated with these complications; (3) determine impact complications on patient outcome.This was a prospective, observational cohort study pediatric, cardiac, neonatal intensive care units eight hospitals,...
Objective: To investigate significant new morbidities associated with pediatric critical care. Design: Randomly selected, prospective cohort. Setting: PICU patients from eight medical and cardiac PICUs. Patients: This was a randomly cohort of Measurements Main Results: The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores morbidity defined as an increase in the more than or equal to 3. Of 5,017 patients, there 242 (4.8%), 99 deaths...
Severity of illness measures have long been used in pediatric critical care. The Pediatric Risk Mortality is a physiologically based score to quantify physiologic status, and when combined with other independent variables, it can compute expected mortality risk morbidity risk. Although the ranges for variables not changed, recent data collection improvements made adapt new practice patterns, minimize bias, reduce potential sources error. These include changing outcome hospital survival/death...
Knowledge of the long-term outcomes survivors pediatric critical illness is sparse but important. The aim this study was to evaluate morbidity and mortality 6 months 3 years after hospital discharge.Prospective cohort study.Urban, inner city, academic PICU.Consecutive patients admitted PICU from June 2012 August 2012.None.We collected descriptive demographic information functional status assessments at baseline, admission, discharge, following discharge. Functional measured with Status...
To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes.Multicenter prospective observational study children younger than 18 years old randomly selected intensively followed from PICU admission to hospital discharge Collaborative Pediatric Critical Care Research Network December 2011 April 2013.Among 10,078 enrolled, 139 (1.4%) received for more or equal 1 minute and/or defibrillation. Of these children, 78% attained return circulation, 45% survived...
Functional status assessment methods are important as outcome measures for pediatric critical care studies.To investigate the relationships between 2 functional appropriate large-sample studies, Status Scale (FSS) and Pediatric Overall Performance Category Cerebral (POPC/PCPC) scales.Prospective cohort study with random patient selection at 7 sites 8 children's hospitals general/medical cardiac/cardiovascular intensive units (PICUs) in Collaborative Critical Care Research Network....
Assessments of care including quality assessments adjusted for physiological status should include the development new morbidities as well mortalities. We hypothesized that morbidity, like mortality, is associated with dysfunction and could be predicted simultaneously mortality.Prospective cohort study from December 4, 2011, to April 7, 2013.General cardiac/cardiovascular PICUs at seven sites.Randomly selected PICU patients their first admission.None.Among 10,078 admissions, unadjusted...
Objective To compare outcomes from pediatric intensive care in hospitals with different levels of resources. Design Prospective, blinded comparison outcome and Setting Tertiary (n = 3) nontertiary 71) Oregon southwestern Washington. Patients All critically ill children admitted respiratory failure head trauma for 6 months. Measurements Main Results Severity illness adjusted mortality rates were determined using admission day, physiologic profiles (Pediatric Risk Mortality score) modalities...
The association of multiple organ system failure (MOSF) with mortality was investigated in 831 consecutive admissions to a pediatric ICU. incidence MOSF (at least two failures, OSF) 27%. Of the 62 nonsurvivors, 60 (97%) had MOSF. for patients 54%, compared 0.3% without Mortality increased directly increasing number OSF (p <.0001). 1% one OSF, 11% 50% three and 75% four OSF. Comparison these results data from adult ICU indicates that clinical course children is distinct adults. significantly...
<h3>Objective.</h3> —To determine the importance of following care factors previously associated with hospital quality on survival from pediatric intensive care: size unit (ICU), medical school teaching status housing ICU, specialist (pediatric intensivist), and coordination. <h3>Design.</h3> —After a national survey, consecutive case series were collected at 16 sites randomly selected to represent unique combinations quality-of-care factors. <h3>Setting.</h3> —Pediatric ICUs....
Data from two 3-morith time periods before and after the arrival of a pediatric intensivist were collected prospectively compared to determine intensivist's impact on ICU mortality, use monitoring therapeutic modalities, efficiency bed utilization. Severity illness care modalities determined daily for all patients with Physiologic Stability Index Therapeutic Intervention Scoring System. The only major organizational change in postintensivist period was organization implementation daytime...
Objective: Communicating bad news about a child's illness is difficult task commonly faced by intensive care physicians. Greater understanding of parents' scope experiences with during their hospitalization will help physicians communicate more effectively. Our objective to describe perceptions conversations regarding terminal and death in the pediatric unit (PICU). Design: A secondary analysis qualitative interview study. Setting: Six children's hospitals National Institute Child Health...
Objective To determine the effectiveness of cardiopulmonary rescucitation (CPR) in pediatric intensive care unit (ICU). Design A nonconcurrent cohort study consecutive admissions. Setting Thirty-two ICUs. Patients Consecutive admissions to 32 Interventions None. Measurements and Main Results Pediatric ICU patients were followed for occurrence a arrest (external cardiac massage at least 2 mins). who state continuous on admission, or never achieved stable vital signs, excluded from study....
The association of nutritional depletions with physiologic instability and quantity care was examined in 60 critically ill children. Nutritional status evaluated by anthropometric techniques. Physiologic stability measured the Stability Index Therapeutic Intervention Scoring System. Acute protein-energy malnutrition significantly associated increased (p less than 0.01). This present for total group, children 24 months age, these two groups nonsurvivors excluded. Mortality also acute 0.001)....
Abstract We surveyed nine pediatric intensive care units (ICUs) to compare patient populations and test prospectively the hypothesis that differences in mortality rates were due severity of illness. Age, clinical service, reason for admission (emergency or scheduled), seriousness underlying chronic disease recorded on admission. The illness was assessed day with a physiology-based measure, Physiologic Stability Index. resulting score used group patients according risk. observed numbers ICU...
On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, American Heart Association recommends using to guide pediatric CPR. However, evidence-based targets CPR remain an important knowledge gap for guidelines.